Impact of digital automation of institutional pathways on test-ordering patterns in a primary health care

To evaluate the impact of digital automation of institutional pathways on the adherence of test ordering to evidence-based best practices in a primary care setting for obesity.

Observational, single-center, retrospective study comparing the periods before (2023) and after (2024) the implantation of a clinical decision support system. Outcomes: volume of tests adherent to protocols, distribution of ordering mix (entropy/perplexity), and test-specific differences (Poisson rate ratios). Rates per 100 visits were estimated, and incidence rate ratios (IRR) with 95% confidence intervals (95%CI) were estimated. The Mann-Whitney test was used to compare adherent tests per visit, alongside descriptive analyses (top-10 both in absolute and percentage changes).

Total orders: 347 (before) versus 787 (after); distinct test types: 117 versus 120. Adherent tests: 179 versus 413; IRR=1.63 (95%CI=1.37-1.96; p<0.001). Median of adherent tests per visit: 1.0 (before) versus 3.0 (after) (p=0.027). Perplexity: 70.9 (before) versus 57.6 (after), indicating increased concentration of orders in protocol-based tests. Among the top-10 absolute growth tests, 9/10 were protocol-based; among the top-10 by percentage change, 0/10.

Digital automation of the pathway was associated with greater adherence to institutional protocols and with a test-ordering pattern more concentrated in core protocol tests.