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Can physician laboratory-test requests be influenced by interventions?
Helga Erlingsdóttir1, Ari Jóhannesson, Tinna L Ásgeirsdóttir
1Department of Economics, University of Iceland , Reykjavik , Iceland.
Insights
Implementing structured interventions like guidelines and feedback significantly reduced physician laboratory test requests by 12-52%. Continuous monitoring is key to influencing physician test ordering behaviors.
Area of Science:
- Healthcare Management
- Clinical Laboratory Science
- Health Services Research
Background:
- Unnecessary laboratory test requests contribute to increased healthcare costs.
- Physician test ordering behavior is a significant factor in healthcare expenditure.
- Optimizing laboratory test utilization is crucial for cost containment.
Purpose of the Study:
- To evaluate the impact of structured interventions on physician laboratory test requests.
- To determine if clinical guidelines, education, feedback, and reminder letters can influence test ordering.
- To assess the effectiveness of multifaceted interventions in a hospital setting.
Main Methods:
- A comparative study was conducted between Landspítali University Hospital (intervention) and Akureyri Hospital (control).
- Six types of laboratory tests were analyzed over pre- and post-intervention periods (2007-2013).
- Relative risks and 95% confidence intervals were calculated to compare test utilization between hospitals.
Main Results:
- Multifaceted interventions at Landspítali University Hospital resulted in a significant reduction (12-52%) in laboratory tests compared to the control.
- Relative risk decreased significantly for ASAT, CRP, and GGT tests post-intervention.
- A statistically significant increase in blood culture test requests was observed after guideline implementation.
Conclusions:
- Physician laboratory test requests can be effectively influenced by structured, multifaceted interventions.
- Continuous monitoring and follow-up are essential components for successful intervention implementation.
- Targeted interventions can lead to significant cost savings in laboratory test utilization.
Background:
Laboratory tests affect healthcare costs and unnecessary test requests can thus be a concern. We studied whether it was possible to influence physician laboratory-test requests using four structured interventions: introduction of clinical guidelines, education, feedback, and reminder letters. The interventions occurred at different times at Landspítali University Hospital, Reykjavik, Iceland. Akureyri Hospital, northern Iceland, was used as a control, since no formal interventions were introduced there.
Materials And Methods:
Six types of laboratory tests were analyzed. The relative risk of a laboratory test being conducted at Landspítali University Hospital compared to Akureyri Hospital was calculated for various points in time, as well as the associated 95% confidence intervals. The primary estimates compare the pre- and post-intervention periods (2007-2009 vs. 2010-2013), but also on a monthly basis in order to observe the trends in greater detail.
Results:
Interventions at Landspítali University Hospital led to a significant reduction in the average number of laboratory tests (12-52%, p < 0.001) compared with Akureyri Hospital. Relative risk coefficients of laboratory tests at Landspítali University Hospital (LUH) compared to Akureyri Hospital (AH) were calculated pre- and post-guidelines, the relative risk for ASAT, CRP and GGT fell markedly, while ALAT and ALP tests did not show a significant decrease. Relative risk for a blood culture test in the period after the guidelines was statistically significantly increased.
Conclusion:
It is possible to influence physician laboratory-test requests using multifaceted interventions that include continuous monitoring and follow-up.
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