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Changing test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with

F Davidoff1, R Goodspeed, J Clive

  • 1Department of Medicine, New Britain General Hospital, Connecticut.

Medical Care
|January 1, 1989
PubMed
Summary

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Teaching medical interns probabilistic reasoning reduced laboratory test orders by 16%. This intervention improved test ordering efficiency, particularly for multitest panels, without altering case mix.

Area of Science:

  • Medical Education
  • Clinical Decision Making
  • Health Services Research

Background:

  • Medical test ordering is a significant driver of healthcare costs.
  • Optimizing diagnostic test utilization is crucial for improving healthcare efficiency and patient outcomes.
  • Intern physicians' test ordering behaviors are often unrefined and can be influenced by educational interventions.

Purpose of the Study:

  • To evaluate the impact of a probabilistic reasoning curriculum on medical interns' laboratory test ordering behavior.
  • To determine if targeted education can reduce unnecessary diagnostic testing in a hospital setting.

Main Methods:

  • A controlled trial was conducted with 24 medical interns randomly assigned to a probabilistic reasoning curriculum group or a placebo group.

Related Experiment Videos

  • Test ordering patterns were analyzed four months after the curriculum sessions.
  • Differences in test ordering were assessed in relation to case mix and length of stay.

    • Main Results:

    • Interns in the probabilistic reasoning group ordered 16% fewer "little ticket" laboratory tests compared to the placebo group (P = 0.032).
    • The probabilistic reasoning group showed reduced ordering for ten specific tests, with multitest panels being particularly affected.
    • These ordering differences were observed across university, veterans, and community hospitals, with the most significant impact in community hospitals.

    Conclusions:

    • A curriculum focused on probabilistic reasoning effectively reduces unnecessary laboratory test orders among medical interns.
    • Educational interventions targeting clinical reasoning can enhance the efficiency of diagnostic test utilization in hospitals.
    • The findings suggest that probabilistic reasoning training is a valuable tool for improving healthcare resource management.