Curtailing laboratory test ordering in a managed care setting through redesign of a computerized order form

Area of Science:

• Clinical Pathology
• Health Services Research
• Medical Informatics

Background:

• Overutilization of laboratory tests can lead to increased healthcare costs and potential patient harm.
• Computerized physician order entry (CPOE) systems offer opportunities to optimize test ordering practices.
• Specific interventions are needed to curb unnecessary laboratory test utilization in primary care.

Purpose of the Study:

• To enhance the appropriate utilization of folic acid and vitamin B12 blood tests.
• To reduce the number of potentially unnecessary laboratory orders placed by primary care physicians.
• To evaluate the impact of a redesigned computerized order form on test ordering patterns.

Main Methods:

• A pre-post intervention study design was employed.
• A managed care organization in Israel implemented a redesigned computerized order form.
• Utilization patterns of vitamin B12, folic acid, and ferritin tests were analyzed before and after the intervention. Hemoglobin and iron tests served as control groups.

Main Results:

• A significant reduction in ordered folic acid and vitamin B12 tests was observed, ranging from 31% to 41% post-intervention.
• Further decreases in test utilization were noted in the subsequent month (36% to 53%).
• Control tests (hemoglobin and iron) showed negligible changes (-2% to 3%), indicating the intervention's specificity.

Conclusions:

• A straightforward redesign of a computerized order form effectively decreased the frequency of potentially unnecessary laboratory tests.
• This study highlights the importance of evaluating ordering procedures to improve laboratory resource efficiency.
• Managers should consider optimizing CPOE systems before implementing more resource-intensive interventions to control test overutilization.