Journal:The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - A randomized controlled trial
| Full article title | The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - A randomized controlled trial |
|---|---|
| Journal | BMC Medical Informatics and Decision Making |
| Author(s) | Martins, C.M.; da Costa Teixeira, A.S.; de Azevedo. L.F.; Sá, L.M.; Santos, P.A.; do Couto, M.L.; da Costa Pereira, A.M.; Hespanhol, A.A.; da Costa Santos, C.M. |
| Author affiliation(s) | University of Porto |
| Primary contact | E-mail: carlosmartins20 at gmail dot com |
| Year published | 2017 |
| Volume and issue | 17 (1) |
| Page(s) | 20 |
| DOI | 10.1186/s12911-017-0416-6 |
| ISSN | 1472-6947 |
| Distribution license | Creative Commons Attribution 4.0 International |
| Website | https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-017-0416-6 |
| Download | https://bmcmedinformdecismak.biomedcentral.com/track/pdf/10.1186/s12911-017-0416-6 (PDF) |
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Abstract
Background: The way software for electronic health records and laboratory tests ordering systems are designed may influence physicians’ prescription. A randomized controlled trial was performed to measure the impact of a diagnostic and laboratory tests ordering system software modification.
Methods: Participants were family physicians working and prescribing diagnostic and laboratory tests.
The intervention group had modified software with basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support system based on United States Preventive Services Task Force (USPSTF) recommendations. This intervention group was compared with typically used software (control group).
The outcomes were the number of tests prescribed from those: withdrawn from the basic menu; added to the basic menu; marked with green dots (USPSTF’s grade A and B); and marked with red dots (USPSTF’s grade D).
Results: Comparing the monthly average number of tests prescribed before and after the software modification, from those tests that were withdrawn from the basic menu, the control group prescribed 33.8 tests per 100 consultations before and 30.8 after (p = 0075); the intervention group prescribed 31.3 before and 13.9 after (p < 0001). Comparing the tests prescribed between both groups during the intervention, from those tests that were withdrawn from the basic menu, the intervention group prescribed a monthly average of 14.0 vs. 29.3 tests per 100 consultations in the control group (p < 0.001). From those tests that are USPSTF’s grade A and B, the intervention group prescribed 66.8 vs. 74.1 tests per 100 consultations in the control group (p = 0.070). From those tests categorized as USPSTF grade D, the intervention group prescribed an average of 9.8 vs. 11.8 tests per 100 consultations in the control group (p = 0.003).
Conclusions: Removing unnecessary tests from a quick shortcut menu of the diagnosis and laboratory tests ordering system had a significant impact and reduced unnecessary prescription of tests.
The fact that it was not possible to perform the randomization at the family physicians’ level, but only on the computer servers is a limitation of our study. Future research should assess the impact of different test ordering systems during longer periods.
Trial registration: ISRCTN45427977, May 1st 2014 (retrospectively registered).
Keywords: Preventive health services, primary health care, evidence-based practice, decision support systems, clinical decision making, computer-assisted
References
Notes
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