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A review on laboratory tests' utilization: A trigger for cutting costs and quality improvement in health care
Zahra Meidani1, Mehrdad Farzandipour2, Alireza Farrokhian3
1PhD, Assistant Professor, Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health, Kashan University of Medical Sciences, Kashan, Iran. meydani-za@kaums.ac.ir.
Insights
Overutilization of laboratory tests in Iran leads to significant health expenditure. Inappropriate test ordering (26.40%) was more common than inefficient tests (1.50%), necessitating physician education and improved lab practices.
Area of Science:
- Clinical Pathology
- Health Economics
- Medical Laboratory Science
Background:
- Laboratory tests are crucial for managing healthcare costs.
- Overutilization of laboratory diagnostics presents a significant challenge in healthcare systems.
- This study addresses laboratory test overutilization in Iran to inform interventions.
Purpose of the Study:
- To investigate the extent and nature of laboratory test overutilization in Iran.
- To categorize overutilized tests into inappropriate and inefficient types.
- To provide data for developing targeted interventions to control healthcare expenditure.
Main Methods:
- A cross-sectional survey utilizing retrospective analysis of 384 medical records.
- Classification of overutilized laboratory tests into 'inappropriate' and 'inefficient' categories.
- Frequency analysis of patient demographics, hospital ward, length of stay, diagnosis, and test utilization patterns.
Main Results:
- 1.50% of laboratory tests were classified as inefficient, often due to laboratory errors (e.g., hemolysis, sampling issues, absurd results).
- A substantial 26.40% of tests were deemed inappropriate, failing to meet clinical appropriateness criteria.
- Inappropriate test ordering significantly exceeded the rate of inefficient tests.
Conclusions:
- Physician test ordering behavior requires focused improvement strategies, including education, audit, feedback, and health IT tools.
- Implementation of laboratory practice guidelines and testing algorithms is recommended to reduce inappropriate test ordering.
- Continuous quality improvement for laboratory services and personnel training are essential for addressing inefficient tests.
Background:
Considering the role of laboratory tests as a central part of controlling health expenditure, this study intends to investigate laboratory tests overutilization in Iran to pave the way for future interventions.
Methods:
Inappropriate laboratory utilization was reviewed in a cross-sectional survey through the retrospective analysis of 384 medical records at a tertiary center. To pave the way for future intervention, overutilization tests were classified into two categories, inappropriate and inefficient, and then they were analyzed. Frequency analysis was used to analysis patient's age, gender, hospital wards, length of stay, and diagnosis as well as inappropriate test and inefficient tests.
Results:
A total of 143 (1.50 %) of the tests were inefficient and was ordered due to laboratory errors including hemolysis, inefficient sampling, or absurd results. 2522 (26.40%) of the tests were inappropriate and stem from failure to meet medical/clinical appropriateness criteria.
Conclusion:
Whereas, inappropriate test ordering was more frequent than inefficient tests, the initial improvement strategy should focus on physicians' test ordering behavior through conducting proper teaching strategies, ongoing audit and educational feedback, implementing health information technology tools and employing laboratory practice guidelines (LPGs) and testing algorithms. Conducting continuous quality improvement cycle for laboratory services and training of personnel involved in blood sampling is recommended for inefficient tests.
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