Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2017 Feb 20;17(1):20.
doi: 10.1186/s12911-017-0416-6.

The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial

Carlos Manuel Silva Martins  1   2 , Andreia Sofia da Costa Teixeira  3 , Luís Filipe Ribeiro de Azevedo  4 , Luísa Maria Barbosa Sá  5 , Paulo Alexandre Azevedo Pereira Santos  5 , Maria Luciana Gomes Domingues do Couto  5 , Altamiro Manuel Rodrigues da Costa Pereira  4 , Alberto Augusto Oliveira Pinto Hespanhol  5 , Cristina Maria Nogueira da Costa Santos  4
Affiliations
Randomized Controlled Trial

The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial

Carlos Manuel Silva Martins et al. BMC Med Inform Decis Mak. .

Abstract

Background: The way software for electronic health records and laboratory tests ordering systems are designed may influence physicians' prescription. A randomised 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 The intervention group had a modified software with a basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support based on United States Preventive Services Task Force (USPSTF) recommendations. This intervention group was compared with usual 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 The outcomes were the number of tests prescribed from those: withdrawn from the basic menu; added to the basic menu; marked with green dots (USPSTF's grade A and B); and marked with red dots (USPSTF's grade D).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the monthly average number of tests prescribed before and after the software modification, from those tests that were withdrawn from the basic menu, the control group prescribed 33.8 tests per 100 consultations before and 30.8 after (p = 0075); the intervention group prescribed 31.3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, intervention group prescribed 66.8 vs. 74.1 tests per 100 consultations in the control group (p = 0.070). From those tests categorised 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 of the computer servers is a limitation of our study. Future research should assess the impact of different tests ordering systems during longer periods.

Trial registration: ISRCTN45427977 , May 1st 2014 (retrospectively registered).

Keywords: Decision making, computer-assisted; Decision support systems, clinical; Evidence-based practice; Preventive health services; Primary health care.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Usual ordering communication system: the basic shortcut menu
Fig. 2
Fig. 2
Modified ordering communication system: the basic shortcut menu. Red numbers: 1- Traffic lights coloured dots according to United States Preventive Services Task Force recommendations grades. 2- Text box with the summary of the recommendation for each selected test. 3-Link to the original recommendation at the USPSTF’s website. 4-Search for tests box, where any test, including those removed from the basic menu, can be searched and requested by typing the test’s name. 5- Legend of the coloured dots
Fig. 3
Fig. 3
Flowchart summary of the trial
See this image and copyright information in PMC

References

    1. Glasziou P, Moynihan R, Richards T, Godlee F. Too much medicine; too little care. BMJ. 2013;347:f4247. doi: 10.1136/bmj.f4247. - DOI - PubMed
    1. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012;344:e3502. doi: 10.1136/bmj.e3502. - DOI - PubMed
    1. Getz L, Sigurdsson JA, Hetlevik I. Is opportunistic disease prevention in the consultation ethically justifiable? BMJ. 2003;327(7413):498–500. doi: 10.1136/bmj.327.7413.498. - DOI - PMC - PubMed
    1. Raposo VL. Electronic health records: Is it a risk worth taking in healthcare delivery? GMS Health Technol Assess. 2015;11:Doc02. - PMC - PubMed
    1. Ben-Assuli O. Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy Amst Neth. 2015;119(3):287–97. doi: 10.1016/j.healthpol.2014.11.014. - DOI - PubMed

Publication types

MeSH terms

Associated data