MedicalResearch.com Interview with:
Victoria Valencia, MPH
Assistant Director for Healthcare Value
Dell Medical SchoolThe University of Texas at Austin
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We were surprised to find that despite the common anecdote that resident physicians in teaching environments order more lab tests, there was a lack of empirical data to support the claim that more lab tests are ordered for patients at teaching hospitals than at non-teaching hospitals. Our study of 43,329 patients with pneumonia or cellulitis across 96 hospitals in the state of Texas found that major teaching hospitals order significantly more lab tests than non-teaching hospitals. We found this to be true no matter how we looked at the data, including when restricting to the least sick patients in our dataset. We also found that major teaching hospitals that ordered more labs for pneumonia tended to also more labs for cellulitis, indicating there is some effect from the environment of the teaching hospital that affects lab ordering overall.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: If you are a patient at a major teaching hospital in the state of Texas for pneumonia or cellulitis, you will likely receive more lab tests than if you went to a non-teaching hospital. While we could not tell from our data whether the increased testing at teaching hospitals was appropriate, we found increased testing even in the least sick patients in our dataset, who were unlikely to have gotten any healthier from the additional lab tests.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research should focus on examining what potential cultural or structural differences there are between teaching and non-teaching environments that may contribute to increased lab testing. We would also benefit from more research on the long term outcomes of pneumonia and cellulitis patients discharged from teaching and non-teaching hospitals.
MedicalResearch.com: Is there anything else you would like to add?
Response: While I think this study certainly has implications that affect physicians, it also affects the patients they care for. Patients often get stuck with a needle for labs at 4 or 5am in the hospital, and we know there are other downstream harms that result from overtesting. Physicians should be mindful of this when deciding to order labs. Perhaps there are opportunities to skip morning labs for patients and let them get some restful, healing sleep.
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Valencia V, Arora VM, Ranji SR, Meza C, Moriates C. A Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions. JAMA Intern Med. Published online November 13, 2017. doi:10.1001/jamainternmed.2017.6032
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