An education program to reduce unnecessary laboratory tests by residents

Area of Science:

• Health Services Research
• Medical Education
• Primary Care

Background:

• Laboratory tests and X-rays constitute a significant portion (25-30%) of healthcare expenditures.
• Understanding drivers of test ordering is crucial for optimizing healthcare resource allocation.
• Complete blood count (CBC) with differential is a high-volume, low-cost test; thyroid stimulating hormone (TSH) is a low-volume, high-cost test.

Purpose of the Study:

• To evaluate the impact of a quality improvement educational intervention on the ordering rates of CBC and TSH tests by family practice residents.
• To assess the sustainability of intervention effects on test ordering and clinical appropriateness.

Main Methods:

• A nine-week study involving 20 family practice residents at an inner-city community health center.
• Implementation of a quality improvement educational intervention focused on appropriate test ordering.
• Utilized audit feedback systems to monitor test ordering patterns for CBC and TSH tests.

Main Results:

• Significant reductions were observed in the ordering rates of TSH tests (p < .0001) and CBCs (p = .05).
• The reduction in ordering rates persisted five months after the intervention concluded.
• Clinically indicated TSH tests increased significantly during the intervention (p < .001), though this effect showed signs of diminishing post-intervention.

Conclusions:

• A targeted educational intervention can effectively reduce the ordering of common laboratory tests, including high-cost TSH and high-volume CBCs.
• The observed reductions in test ordering and improvements in TSH test appropriateness demonstrate the potential for sustained impact on clinical practice.
• Long-term sustainability of improved test appropriateness requires ongoing monitoring and reinforcement.