Improving laboratory usage: a review

Young, David W.

doi:10.1136/pgmj.64.750.283

Cited by 49 publications

(52 citation statements)

References 34 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%

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%

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

“…On the other hand, feedback about excessive ordering of 1 test, such as serum calcium, without comparative feedback, did not result in a significant reduction in ordering. 8 We hypothesized that physicians-in-training are not currently receiving feedback-especially not comparative feedback-on their resource utilization. Even if given, we hypothesized that this feedback was rarely used to implement an intervention.…”

Section: Resultsmentioning

confidence: 99%

Educating Physicians-in-Training About Resource Utilization and Their Own Outcomes of Care in the Inpatient Setting

Dine¹,

Miller²,

Fuld³

et al. 2010

Journal of Graduate Medical Education

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Background Despite significant policy concerns about the role of inpatient resource utilization on rising medical costs, little information is provided to residents regarding their practice patterns and the effect on resource use. Improved knowledge about their practice patterns and costs might reduce resource utilization and better prepare physicians for today's health care market. Methods We surveyed residents in the internal medicine residency at the Hospital of the University of Pennsylvania. Based on needs identified via the survey, discussions with experts, and a literature review, a curriculum was created to help increase residents' knowledge about benchmarking their own practice patterns and using objective performance measures in the health care market. Results The response rate to our survey was 67%. Only 37% of residents reported receiving any feedback on their utilization of resources, and only 20% reported receiving feedback regularly. Even fewer (16%) developed, with their attending physician, a concrete improvement plan for resource use. A feedback program was developed that included automatic review of the electronic medical record to provide trainee-specific feedback on resource utilization and outcomes of care including number of laboratory tests per patient day, laboratory cost per patient day, computed tomography scan ordering rate, length of stay, and 14-day readmission rate. Results were benchmarked against those of peers on the same service. Objective feedback was provided biweekly by the attending physician, who also created an action plan with the residents. In addition, an integrated didactic curriculum was provided to all trainees on the hospitalist service on a biweekly basis. Conclusions Interns and residents do not routinely receive feedback on their resource utilization or ways to improve efficiency. A method for providing objective data on individual resource utilization in combination with a structured curriculum can be implemented to help improve resident knowledge and practice. Ongoing work will test the impact on resource utilization and outcomes.

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“…Diagnostic tests are often overused in modern medicine: one study found that "65% of laboratory tests, 11% of CXRs, and 26% of nursing services could not be justified" [29]. This may be a function of physicians' limited knowledge of diagnostic test cost.…”

Section: "Investigations"mentioning

confidence: 99%

The Utilization of the iOS Platform to Create LearnENT: An Interactive Educational App in Otolaryngology—Head and Neck Surgery

Kohlert

Scherer

Kherani

et al. 2012

Education Research International

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LearnENT, an educational app for iOS, was developed to promote a standardized experience otolaryngology in head and neck surgery (OTOHNS) for University of Ottawa medical students. Its development was grounded in pedagogical theory including Laurillard's design process, Honey and Mumford's learning styles, and Nielsen's theory of usability. This paper examines LearnENT's design and development processes as well as the role of mobile apps in medical education. Features of the LearnENT app as they apply to Constructivist learning are also highlighted.

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Improving laboratory usage: a review

Cited by 49 publications

References 34 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

Educating Physicians-in-Training About Resource Utilization and Their Own Outcomes of Care in the Inpatient Setting

The Utilization of the iOS Platform to Create LearnENT: An Interactive Educational App in Otolaryngology—Head and Neck Surgery

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