A Review of Physician Cost-Containment Strategies for Laboratory Testing

Grossman, Randolph M.

doi:10.1097/00005650-198308000-00003

Cited by 92 publications

(35 citation statements)

References 72 publications

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“…Several systematic and narrative reviews have been published on this topic [5][6][7][8]. The most recent review, published in 1998, used a behavioral framework to classify interventions and found that targeting multiple behavioral factors was more successful than targeting a single factor [8].…”

Section: Introductionmentioning

confidence: 99%

“…However, this review only dichotomized study outcomes by statistical significance, making it difficult to understand the utility of these interventions. Other reviews used categories of education, audit and feedback or other but were unable to make generalizations about which strategy is most effective because of differences within each category of intervention, a wide range of effects, and lack of a common measure [5,6]. To date, no review has quantitatively compared the influence of various interventions on test utilization reduction.…”

Section: Introductionmentioning

confidence: 99%

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Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review

Kobewka¹,

Ronksley

McKay

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Laboratory and radiographic tests are often ordered unnecessarily. This excess testing has financial costs and is a burden on patients. We performed a systematic review to determine the effectiveness interventions to reduce test utilization by physicians. The MEDLINE and EMBASE databases were searched for the years 1946 through to September 2013 for English articles that had themes of test utilization and cost containment or optimization. Bibliographies of included papers were scanned to identify other potentially relevant studies. Our search resulted in 3236 articles of which 109 met the inclusion criteria of having an intervention aimed at reducing test utilization with results that could be expressed as a percent reduction in test use relative to the comparator. Each intervention was categorized into one or more non-exclusive category of education, audit and feedback, system based, or incentive or penalty. A rating of study quality was also performed. The percent reductions in test use ranged from a 99.7% reduction to a 27.7% increase in test use. Each category of intervention was effective in reducing test utilization. Heterogeneity between interventions, poor study quality, and limited time horizons makes generalizations difficult and calls into question the validity of results. Very few studies measure any patient safety or quality of care outcomes affected by reduced test use. There are numerous studies that use low investment strategies to reduce test utilization with one time changes in the ordering system. These low investment strategies are the most promising for achievable and durable reductions in inappropriate test use.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review

Kobewka¹,

Ronksley

McKay

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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show abstract

“…Past reviews of this subject [14][15][16][17][18] have not discriminated among tests used for screening, diagnosis, or monitoringclinical situations that profoundly impact physicians' motivation and willingness to tolerate uncertainty and their test ordering behavior. Interventions aimed at screening generally have used accepted algorithms and attempt to enhance test usage, quite a different challenge than tests used for diagnosis, which are gener-…”

mentioning

confidence: 99%

“…Studies of interventions to modify physicians' test ordering behavior suggest that behavior See also pp 2028 and 2036. change rarely can be accomplished solely through education, feedback of laboratory utilization data has inconsistent effects, rewarding physicians for improved ordering practices may result in short-term behavior change only, and testing guidelines have a variable effect depending on the implementation of the guidelines. [13][14][15][16][17] Nearly every strategy has had both success and failure, providing limited guidance for designing new or more effective strategies.…”

mentioning

confidence: 99%

Techniques to Improve Physicians' Use of Diagnostic Tests

Solomon¹,

Hashimoto²,

Daltroy³

et al. 1998

JAMA

284

203

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“…It is believed that feedback acts upon the physician's sense of achievement and desire to excel. It activates self-regulation (Eisenberg, 1986;Geertsma et aL, 1982;Grossman, 1983).…”

Section: Introductionmentioning

confidence: 99%

The diluting effect of medical work groups on feedback efficacy in changing physician's practice

et al. 1996

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Feedback intervention has been advocated as a successful method to modify the way that physicians practice medicine. However, most studies concerned with modifying physician profiles have focused on interns and residents. The results presented here concern regular staff and therefore provide a better basis for generalization. Over a 2.5-year period, we analyzed the use of clinical resources by physicians practicing in four medical specialties in two hospitals. Hierarchical multiple regression models were used to control case mix in order to identify the specific effects attributable to feedback. The information failed to modify the physicians' practice profiles. Our results suggest that this failure is related to the organization of inpatient medical practice as a group effort. This mode of practice has a negative effect on feedback efficacy. First, it weakens one of the main feedback mechanisms, that is personal identification with the data. Second, it probably generates mutual adjustment among physicians, thus eliminating practice variations at the source.

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A Review of Physician Cost-Containment Strategies for Laboratory Testing

Cited by 92 publications

References 72 publications

Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review

Influence of educational, audit and feedback, system based, and incentive and penalty interventions to reduce laboratory test utilization: a systematic review

Techniques to Improve Physicians' Use of Diagnostic Tests

The diluting effect of medical work groups on feedback efficacy in changing physician's practice

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