Influencing Behavior of Physicians Ordering Laboratory Tests

Axt-Adam, P; Wouden, Johannes C. van der; Does, E. van der

doi:10.1097/00005650-199309000-00003

Cited by 169 publications

(100 citation statements)

References 95 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

“…We chose to narrow in on reviewing interventions specifically looking at real time charge display and its effect on physician decisions, rather than the broader topic of performance feedback, which was thoroughly explored in a recent Cochrane Review by Ivers et al, 9 as well as more general literature review by Axt-Adam et al in the early 1990s. 10 We would like to comment on terminology at this juncture. The terms Bprice,^Bcost,^Bcharge,^and Bfee^are often used interchangeably in this literature, even though there are nuanced differences to these terms.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

Rotman

Hartoularos

et al. 2015

J GEN INTERN MED

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BACKGROUND: While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted. OBJECTIVE: We aimed to determine the type and quality of charge display studies that have been published; to synthe-size this information in the form of a literature review. METHODS: English-language articles published between 1982 and 2013 were identified using MEDLINE, Web of Knowledge, ABI-Inform, and Academic Search Premier. Article titles, abstracts, and text were reviewed for relevancy by two authors. Data were then extracted and subsequently synthesized and analyzed. RESULTS: Seventeen articles were identified that fell into two topic categories: the effect of charge display on radiology and laboratory test ordering versus on medication choice. Seven articles were randomized controlled trials, eight were pre-intervention vs. post-intervention studies, and two interventions had a concurrent control and intervention groups, but were not randomized. Twelve studies were conducted in a clinical environment, whereas five were survey studies. Of the nine clinically based interventions that examined test ordering, seven had statistically significant reductions in cost and/or the number of tests ordered. Two of the three clinical studies looking at medication expenditures found significant reductions in cost. In the survey studies, physicians consistently chose fewer tests or lower cost options in the theoretical scenarios presented. CONCLUSIONS: In the majority of studies, charge information changed ordering and prescribing behavior.KEY WORDS: charge display; physician behavior; costs of care.

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“…There have been numerous attempts over the past four decades to modify the laboratory test ordering behavior of physicians, mostly because of perceived or real overutilization (1)(2)(3)(4)(5)(6)(7)(8). Many of these studies did not use a control group, and most control groups that were used were historical (8 ) and were subject to biases such as the Hawthorne effect (improved behavior while under observation) (9 ).…”

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confidence: 99%

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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Influencing Behavior of Physicians Ordering Laboratory Tests

Cited by 169 publications

References 95 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

The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

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

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