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Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes
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Rates of inappropriate laboratory test utilization in Ontario.

Nadine Chami1, Janet E Simons2, Arthur Sweetman1

  • 1Department of Economics, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada.

Clinical Biochemistry
|May 10, 2017
PubMed
Summary

A significant portion of medical laboratory tests are repeated unnecessarily, often by the same physician, leading to increased costs and potentially impacting patient care. Interventions are needed to prevent redundant testing and optimize diagnostic resource utilization.

Keywords:
Inappropriate testingMedical laboratory utilizationRedundant testingRepeat testing

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Area of Science:

  • Health Services Research
  • Clinical Pathology
  • Health Informatics

Background:

  • Redundant medical laboratory tests are a target for reducing healthcare costs without compromising patient care.
  • Excessive laboratory utilization, defined by premature test ordering, impacts diagnostic efficiency.

Purpose of the Study:

  • To quantify the extent of inappropriate repeat testing for nine common analytes.
  • To identify patterns in physician ordering behavior contributing to redundant laboratory utilization.

Main Methods:

  • Analysis of population-based data from the Ontario Health Insurance Plan (2006-2010).
  • Inclusion of nine specific analytes: thyroid stimulating hormone, hemoglobin A1c, lipid profile, serum protein electrophoresis, immunofixation, quantitative immunoglobulins, Vitamin D, Vitamin B12, and folate.
  • Definition of inappropriate testing based on intervals between repeat orders.

Main Results:

  • Inappropriate tests ranged from 6% to 20% for the studied analytes.
  • A substantial percentage of these inappropriate tests were ordered more than two weeks before guideline-recommended reorder intervals.
  • Ordering physicians were frequently the same for repeated tests (60-85%), with specialists more prone to premature reordering.

Conclusions:

  • A considerable proportion of laboratory testing for key analytes is inappropriate per clinical guidelines.
  • Funding agencies should explore systems to prevent unnecessary repeat testing.
  • Reducing inappropriate testing should be integrated into the design of electronic medical records and health IT systems.