Reducing Daily Laboratory Tests in a Rural-Serving Health System: Insights and Challenges.

Area of Science:

• Health services research
• Quality improvement science
• Rural health delivery

Background:

• Laboratory test utilization initiatives are primarily studied in academic settings, with less research in rural and community hospitals.
• The EPIDEM model was applied across a nine-hospital rural health system to decrease unnecessary daily laboratory tests.

Purpose of the Study:

• To implement and evaluate the EPIDEM model for reducing daily laboratory test utilization in a predominantly rural health system.
• To assess the effectiveness of electronic health record (EHR) interventions and social strategies in sustaining test reductions.

Main Methods:

• The EPIDEM model (exploration, promotion, implementation, documentation, evaluation, modification) guided the initiative.
• Key partners were engaged starting October 2020, with system-wide EHR interventions implemented in April 2021.
• Regional hospitals received EHR interventions and educational materials, while the medical center received additional support.

Main Results:

• A 6%-20% reduction in tests per inpatient day was observed across the health system.
• The medical center demonstrated sustained ordering decreases following EHR interventions.
• Regional hospitals experienced initial increases in ordering before a decrease, ultimately returning near baseline levels.

Conclusions:

• Sustaining daily laboratory test reductions necessitates social and behavioral strategies.
• Local champions at each hospital may be crucial for achieving lasting cultural change.
• The EPIDEM model facilitates quality improvement by emphasizing relational and contextual factors in resource-limited settings.