Measuring the Effectiveness of Choosing Wisely Campaign on Laboratory Testing for Hospitalized Patients

Since the start of the Choosing Wisely Campaign (CWC) in 2012, there have been multiple interventions to curb unnecessary laboratory testing. However, no study has examined the impact of the CWC on laboratory tests in an inpatient setting. The objective of this study was to determine if the CWC is associated with a decrease in the number of laboratory tests performed during hospitalization.

A retrospective study was conducted at a tertiary care academic hospital using data from January 2008 through September 2018. Data on age, gender, race, length of stay, and the date of common laboratory tests were collected. Data were categorized into pre-campaign (2008-2010), early-campaign (2013-2015), and late-campaign (2016-2018) periods.

Of the 10,510,491 labs, 4,637,250 (44.1%) were performed on females, and 5,005,847 (47.6%) on African Americans. The mean (standard deviation [SD]) age of the total population was 51.7 (17.9) years, and the length of hospitalization was 6.3 (9.1) days. Using generalized linear models, the researchers found that overall laboratory tests increased by 8.6% in the late-campaign compared with the pre-campaign period (adjusted p < 0.0001). The percentage changes translate into the following number of additional tests per 100 patient-days during the late-campaign period compared with the pre-campaign period: sodium 8.6, potassium 7.9, hemoglobin 7.1, creatinine 7.1, magnesium 3.9, and alanine transferase 2.4.

The findings of this study, if validated by data from other institutions, will suggest the need for better implementation strategies for high-value care. Future research exploring an effective strategy for delivering high-value care is needed.