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. 1988 Apr;64(750):283–289. doi: 10.1136/pgmj.64.750.283

Improving laboratory usage: a review.

D W Young 1
PMCID: PMC2428514  PMID: 3054854

Abstract

Influencing the ordering of laboratory investigations, and in particular reducing unnecessary ones, is a vital concern to many hospitals. An account of the reasons why control is necessary is presented. The different methods evaluated are reviewed, including rationing, form design, resource management (budget control), education, protocols and decision support systems, incentives, feedback and case note appraisal. Methods of controlling the requesting of investigations are likely to be ineffective unless they take place in the correct environment. Elements of this include correct attitude and commitment by senior staff, a long term strategy, and different approaches for different groups of doctors.

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Selected References

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  1. Applegate W. B., Bennett M. D., Chilton L., Skipper B. J., White R. E. Impact of a cost-containment educational program on housestaff ambulatory clinic charges. Med Care. 1983 May;21(5):486–496. doi: 10.1097/00005650-198305000-00002. [DOI] [PubMed] [Google Scholar]
  2. Cohen D. I., Jones P., Littenberg B., Neuhauser D. Does cost information availability reduce physician test usage? A randomized clinical trial with unexpected findings. Med Care. 1982 Mar;20(3):286–292. doi: 10.1097/00005650-198203000-00005. [DOI] [PubMed] [Google Scholar]
  3. Dixon R. H., Laszlo J. Ultilization of clinical chemistry services by medical house staff. An analysis. Arch Intern Med. 1974 Dec;134(6):1064–1067. [PubMed] [Google Scholar]
  4. Eisenberg J. M. An educational program to modify laboratory use by house staff. J Med Educ. 1977 Jul;52(7):578–581. doi: 10.1097/00001888-197707000-00006. [DOI] [PubMed] [Google Scholar]
  5. Eisenberg J. M. Physician utilization. The state of research about physicians' practice patterns. Med Care. 1985 May;23(5):461–483. [PubMed] [Google Scholar]
  6. Eisenberg J. M., Williams S. V. Cost containment and changing physicians' practice behavior. Can the fox learn to guard the chicken coop? JAMA. 1981 Nov 13;246(19):2195–2201. [PubMed] [Google Scholar]
  7. Eisenberg J. M., Williams S. V., Garner L., Viale R., Smits H. Computer-based audit to detect and correct overutilization of laboratory tests. Med Care. 1977 Nov;15(11):915–921. doi: 10.1097/00005650-197711000-00005. [DOI] [PubMed] [Google Scholar]
  8. Everett G. D. Impact of supervision by medical teachers and in-patient test control programmes on the out-patient test utilization of residents. Med Educ. 1985 Mar;19(2):138–142. doi: 10.1111/j.1365-2923.1985.tb01154.x. [DOI] [PubMed] [Google Scholar]
  9. Everett G. D., deBlois C. S., Chang P. F., Holets T. Effect of cost education, cost audits, and faculty chart review on the use of laboratory services. Arch Intern Med. 1983 May;143(5):942–944. [PubMed] [Google Scholar]
  10. Fowkes F. G., Davies E. R., Evans K. T., Green G., Hartley G., Hugh A. E., Nolan D. J., Power A. L., Roberts C. J., Roylance J. Multicentre trial of four strategies to reduce use of a radiological test. Lancet. 1986 Feb 15;1(8477):367–370. doi: 10.1016/s0140-6736(86)92327-5. [DOI] [PubMed] [Google Scholar]
  11. Fowkes F. G., Hall R., Jones J. H., Scanlon M. F., Elder G. H., Hobbs D. R., Jacobs A., Cavill I. A., Kay S. Trial of strategy for reducing the use of laboratory tests. Br Med J (Clin Res Ed) 1986 Mar 29;292(6524):883–885. doi: 10.1136/bmj.292.6524.883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Fraser C. G., Woodford F. P. Strategies to modify the test-requesting patterns of clinicians. Ann Clin Biochem. 1987 May;24(Pt 3):223–231. doi: 10.1177/000456328702400301. [DOI] [PubMed] [Google Scholar]
  13. Golden W. E., Pappas A. A., Lavender R. C. Financial unbundling reduces outpatient laboratory use. Arch Intern Med. 1987 Jun;147(6):1045–1048. [PubMed] [Google Scholar]
  14. Grivell A. R., Forgie H. J., Fraser C. G., Berry M. N. League tables of biochemical laboratory costs. An attempt to modify requesting patterns. Med J Aust. 1982 Oct 2;2(7):326–328. doi: 10.5694/j.1326-5377.1982.tb132452.x. [DOI] [PubMed] [Google Scholar]
  15. Grossman R. M. A review of physician cost-containment strategies for laboratory testing. Med Care. 1983 Aug;21(8):783–802. doi: 10.1097/00005650-198308000-00003. [DOI] [PubMed] [Google Scholar]
  16. Hardwick D. F., Vertinsky P., Barth R. T., Mitchell V. F., Bernstein M., Vertinsky I. Clinical styles and motivation: a study of laboratory test use. Med Care. 1975 May;13(5):397–408. doi: 10.1097/00005650-197505000-00002. [DOI] [PubMed] [Google Scholar]
  17. Harper D. R. Disease cost in a surgical ward. Br Med J. 1979 Mar 10;1(6164):647–649. doi: 10.1136/bmj.1.6164.647. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Martin A. R., Wolf M. A., Thibodeau L. A., Dzau V., Braunwald E. A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med. 1980 Dec 4;303(23):1330–1336. doi: 10.1056/NEJM198012043032304. [DOI] [PubMed] [Google Scholar]
  19. Marton K. I., Tul V., Sox H. C., Jr Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. Arch Intern Med. 1985 May;145(5):816–821. [PubMed] [Google Scholar]
  20. Myers L. P., Schroeder S. A. Physician use of services for the hospitalized patient: a review, with implications for cost containment. Milbank Mem Fund Q Health Soc. 1981 Fall;59(4):481–507. [PubMed] [Google Scholar]
  21. Schroeder S. A., Kenders K., Cooper J. K., Piemme T. E. Use of laboratory tests and pharmaceuticals. Variation among physicians and effect of cost audit on subsequent use. JAMA. 1973 Aug 20;225(8):969–973. [PubMed] [Google Scholar]
  22. Schroeder S. A., Martin A. R. Will changing how physicians order tests reduce medical costs? Ann Intern Med. 1981 Apr;94(4 Pt 1):534–536. doi: 10.7326/0003-4819-94-4-534. [DOI] [PubMed] [Google Scholar]
  23. Schroeder S. A., Myers L. P., McPhee S. J., Showstack J. A., Simborg D. W., Chapman S. A., Leong J. K. The failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital. JAMA. 1984 Jul 13;252(2):225–230. [PubMed] [Google Scholar]
  24. Skipper J. K., Jr, Smith G., Mulligan J. L., Garg M. L. Physicians' knowledge of cost: the case of diagnostic tests. Inquiry. 1976 Jun;13(2):194–198. [PubMed] [Google Scholar]
  25. Stilwell J. A., Young D., Cunnington A. Evaluation of laboratory tests in hospitals. Ann Clin Biochem. 1980 Nov;17(6):281–286. doi: 10.1177/000456328001700601. [DOI] [PubMed] [Google Scholar]
  26. Thomas J. C., Moore A., Qualls P. E. The effect on cost of medical care for patients treated with an automated clinical audit system. J Med Syst. 1983 Jun;7(3):307–313. doi: 10.1007/BF00993294. [DOI] [PubMed] [Google Scholar]
  27. Wong E. T., Lincoln T. L. Ready! Fire! . . . Aim! An inquiry into laboratory test ordering. JAMA. 1983 Nov 11;250(18):2510–2513. doi: 10.1001/jama.250.18.2510. [DOI] [PubMed] [Google Scholar]
  28. Wong E. T., McCarron M. M., Shaw S. T., Jr Ordering of laboratory tests in a teaching hospital. Can it be improved? JAMA. 1983 Jun 10;249(22):3076–3080. [PubMed] [Google Scholar]
  29. Young D. W. A survey of decision aids for clinicians. Br Med J (Clin Res Ed) 1982 Nov 6;285(6351):1332–1336. doi: 10.1136/bmj.285.6351.1332. [DOI] [PubMed] [Google Scholar]
  30. Young D. W. An aid to reducing unnecessary investigations. Br Med J. 1980 Dec 13;281(6255):1610–1611. doi: 10.1136/bmj.281.6255.1610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Young D. W. Cost and clinical decisions. J R Coll Physicians Lond. 1983 Jan;17(1):86–87. [PMC free article] [PubMed] [Google Scholar]

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