Effect of a Practice-Based Strategy on Test Ordering Performance of Primary Care Physicians

Verstappen, Wim; Weijden, Trudy van der; Sijbrandij, Jildou; Smeele, Ivo; Hermsen, Jan; Grimshaw, Jeremy; Grol, Richard

doi:10.1001/jama.289.18.2407

Cited by 136 publications

(133 citation statements)

References 16 publications

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“…Indeed, a recent randomized controlled multicenter trial, which targeted specific patient disorders and assessed whether appropriate testing guidelines were being followed, showed only a modest effect of intervention (33 ). The success of intervention in the present study could stem from several factors.…”

Section: Discussionmentioning

confidence: 61%

Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Bunting

Walraven

2004

Clinical Chemistry

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Background: Most studies of interventions to reduce laboratory test utilization have occurred in academic hospital settings, used historical controls, or have had short postintervention follow-up. Interventions with the greatest impact use multiple approaches, are repeated regularly, include comparisons with physician peers, and have a personal approach. We determined whether laboratory test utilization by community physicians could be reduced by a multifaceted program of education and feedback. Methods: We identified 200 physicians who ordered the largest number of common laboratory tests during 1 year in a nonhospital, commercial community (reference) laboratory. They were assigned to intervention and control groups (100 each). Intervention physicians were visited individually up to three times by laboratory representatives over a 2-year period. At each visit, educational material and the physician's personal laboratory test utilization data were presented and discussed briefly in general terms, with the latter compared with utilization data for the physician's peers. Overall test utilization rates 1 year before, during, and 2 years after the intervention were measured using population-based databases. Time-series analysis was used to determine the effect of the intervention on laboratory test utilization.

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Section: Discussionmentioning

confidence: 61%

Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Bunting

Walraven

2004

Clinical Chemistry

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“…Direct costs include test and operator costs, whereas indirect costs are broader including consequences of test results in terms of treatment, implications of inaccurate test results, and longer-term costs in terms of patient outcome. A number of studies have found that clinical guidelines and policy recommendations affect doctors' test ordering, generally by reducing inappropriate test ordering [8,11,12,18,19,21,25,35].…”

Section: Policy and Organization-related Factorsmentioning

confidence: 99%

A review identifies and classifies reasons for ordering diagnostic tests

Whiting¹,

Toerien²,

Salis³

et al. 2007

Journal of Clinical Epidemiology

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Article:Whiting, P., Toerien, M. orcid.org/0000-0003-3159-0931, de Salis, I. et al. (4 more ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. REVIEW ARTICLESA review identifies and classifies reasons for ordering diagnostic tests Study Design and Setting: We reviewed any study of any design that discussed factors that may affect a doctor's decision to order a test. Articles were located through searches of electronic databases, authors' files on diagnostic methodology, and reference lists of relevant studies. We extracted data on: study design, type of analysis, setting, topic area, and any factors reported to influence test ordering.Results: We included 37 studies. We carried out a thematic analysis to synthesize data. Five key groupings arose from this process: diagnostic factors, therapeutic and prognostic factors, patient-related factors, doctor-related factors, and policy and organization-related factors. To illustrate how the various factors identified may influence test ordering we considered the symptom low back pain and the diagnosis multiple sclerosis as examples.Conclusions: A wide variety of factors influence a doctor's decision to order a test. These are integral to understanding diagnosis in clinical practice. Traditional diagnostic accuracy studies should be supplemented with research into the broader context in which doctors perform their work. Ó

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“…In one multicenter randomized trial with a block design, this strategy was indeed found to have a favorable effect on physicians' testordering behavior. 22 A cost analysis of the new strategy and a process evaluation showed that it was a cost-efficient and feasible tool for improvement of physicians' test-ordering behavior. 23,24 This article determines the effects of this innovative, multifaceted strategy, compared with a classic feedback strategy, to assess the added value of the small-group quality improvement meetings.…”

Section: Introductionmentioning

confidence: 99%

Improving Test Ordering in Primary Care: The Added Value of a Small-Group Quality Improvement Strategy Compared With Classic Feedback Only

Verstappen

Weijden²,

Dubois³

et al. 2004

The Annals of Family Medicine

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PURPOSE We wanted to evaluate the added value of small peer-group quality improvement meetings compared with simple feedback as a strategy to improve test-ordering behavior. Numbers of tests ordered by primary care physicians are increasing, and many of these tests seem to be unnecessary according to established, evidence-based guidelines. METHODSWe enrolled 194 primary care physicians from 27 local primary care practice groups in 5 health care regions (5 diagnostic centers). The study was a cluster randomized trial with randomization at the local physician group level. We evaluated an innovative, multifaceted strategy, combining written comparative feedback, group education on national guidelines, and social infl uence by peers in quality improvement sessions in small groups. The strategy was aimed at 3 specifi c clinical topics: cardiovascular issues, upper abdominal complaints, and lower abdominal complaints.The mean number of tests per physician per 6 months at baseline and the physicians' region were used as independent variables, and the mean number of tests per physician per 6 months was the dependent variable. RESULTSThe new strategy was executed in 13 primary care groups, whereas 14 groups received feedback only. For all 3 clinical topics, the decrease in mean total number of tests ordered by physicians in the intervention arm was far more substantial (on average 51 fewer tests per physician per half-year) than the decrease in mean number of tests ordered by physicians in the feedback arm (P = .005). Five tests considered to be inappropriate for the clinical problem of upper abdominal complaints decreased in the intervention arm, with physicians in the feedback arm ordering 13 more tests per 6 months (P = .002). Interdoctor variation in test ordering decreased more in the intervention arm.CONCLUSION Compared with only disseminating comparative feedback reports to primary care physicians, the new strategy of involving peer interaction and social infl uence improved the physicians' test-ordering behavior. To be effective, feedback needs to be integrated in an interactive, educational environment.

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Effect of a Practice-Based Strategy on Test Ordering Performance of Primary Care Physicians

Cited by 136 publications

References 16 publications

Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

A review identifies and classifies reasons for ordering diagnostic tests

Improving Test Ordering in Primary Care: The Added Value of a Small-Group Quality Improvement Strategy Compared With Classic Feedback Only

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