Effect of population-based interventions on laboratory utilization: a time-series analysis

Area of Science:

• Health Services Research
• Clinical Pathology
• Health Policy

Background:

• Previous research on reducing laboratory utilization was often limited by being hospital-based, small-scale, single-centered, or short-term.
• Effective strategies for population-wide laboratory test utilization reduction are needed.

Purpose of the Study:

• To evaluate the impact of three population-based interventions on laboratory utilization in Ontario.
• Interventions included physician guidelines, laboratory requisition form modifications, and funding policy changes.

Main Methods:

• An interventional time-series analysis was conducted using claims data from the Ontario Health Insurance Program (July 1991-April 1997).
• The study focused on clinical laboratories outside of hospitals in Ontario.
• Utilization rates of specific laboratory tests (e.g., ESR, urinalysis, iron, thyroid function) were analyzed before and after interventions.

Main Results:

• Significant decreases in utilization were observed for erythrocyte sedimentation rate (ESR) and urea determination (58% and 57% reduction, respectively).
• Microscopic urinalysis decreased by 14%, while non-microscopic urinalysis increased by 1700% following policy changes.
• Iron determination decreased by 80%, total thyroxine by 96%, and thyroid-stimulating hormone (TSH) by 12%.
• These interventions resulted in savings of over 625,000 tests and $210,400 by April 1997.

Conclusions:

• A combined approach of guideline dissemination, requisition form modification, and funding policy changes effectively reduced laboratory test utilization.
• These population-based interventions demonstrate a successful model for optimizing laboratory resource use.