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A strategy to promote rational clinical chemistry test utilization
A W Lyon1, D C Greenway, J T Hindmarsh
1Department of Pathology and Laboratory Medicine, University of Ottawa, Canada.
American Journal of Clinical Pathology
|June 1, 1995
Summary
A ban on ordering common clinical chemistry test panels, reinforced with reminders, effectively reduced test usage long-term. Physician education alone did not impact ordering patterns.
Area of Science:
- Clinical Chemistry
- Laboratory Medicine
- Healthcare Management
Background:
- Clinical chemistry laboratory tests are frequently over-ordered in North America.
- Existing corrective strategies often lack prolonged effectiveness in reducing test utilization.
Purpose of the Study:
- To design and evaluate a strategy for prolonged reduction in clinical chemistry test ordering.
- To assess the impact of physician education and a ban on test-panel ordering.
Main Methods:
- A pre- and post-intervention survey study design was employed.
- Physician education was followed by a ban on ordering common clinical chemistry test panels.
- Written reminders were used to reinforce the ban for non-adherent physicians.
Main Results:
- Ordering of large test panels (>16 tests) decreased significantly: from 15% to 6% for inpatients and 44% to 11% for outpatients after one year.
- The ban had minimal impact on smaller test panels (7 common tests).
- Educational interventions (newsletters, lectures) showed no effect on ordering rates.
Conclusions:
- A ban on test-panel ordering, reinforced by ongoing reminders, is an effective long-term strategy for reducing clinical chemistry test usage.
- A 38% reduction in common biochemistry tests was achieved, though cost savings were modest.
- Cost-effective laboratory utilization through careful test selection is crucial for medical trainee education.
