28 Jul Reducing Unnecessary Testing Without Harming Patient Outcomes

MedicalResearch.com Interview with:
Renuka S Bindraban, MD and
Prabath W. B. Nanayakkara, MD, PhD
Section of Acute Medicine
Department of Internal Medicine
Amsterdam Public Health Research Institute
Amsterdam UMC Vrije Universiteit Amsterdam,
Amsterdam, the Netherland 

MedicalResearch.com: What is the background for this study?

Response: It is well known that a significant portion of healthcare activities is considered of low-value. Eliminating such low-value care is often targeted in efforts to both contain rapidly increasing healthcare costs as well as maintain high-quality care.

In this context, our study focused on reducing unnecessary laboratory testing. In 2008, our study group performed a multifaceted intervention aimed at reducing unnecessary diagnostic testing at the Internal Medicine department of the Amsterdam University Medical Center, location Vrije Universiteit (VU).

In the ‘Reduction of Unnecessary Diagnostics Through Attitude Change of the Caregivers’, we implemented this successful intervention in the Internal Medicine departments of four large teaching hospitals in the Netherlands. The intervention included creating awareness through education and feedback, intensified supervision of residents, and changes in order entry systems.

MedicalResearch.com: What are the main findings? 

Response:Laboratory test volume per patient contact decreased by 11.4%, whereas the volume increased by 2.4% in 19 comparable hospitals in the Netherlands. Laboratory costs and volumes and costs for other diagnostics also decreased. Clinical outcomes were not negatively affected during the study.

MedicalResearch.com: What should readers take away from your report?

Response: The burden of unnecessary testing can be reduced using a multifaceted intervention, without negatively affecting patient outcomes. Reduction initiatives can be facilitated through education, continuous attention for overuse, feedback on ordering behavior to ordering physicians, and explicitly involving residents in an enthusiastic team of initiative leaders.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: The approach in this study can be used as a framework for future projects aiming to reduce unnecessary laboratory diagnostic tests in routine clinical practice. Future studies might be complemented with involving patients and emphasizing patient-friendly care.

Citation:

Bindraban RS, van Beneden M, Kramer MHH, et al. Association of a Multifaceted Intervention With Ordering of Unnecessary Laboratory Tests Among Caregivers in Internal Medicine Departments. JAMA Netw Open.Published online July 24, 20192(7):e197577. doi:10.1001/jamanetworkopen.2019.7577

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2738624

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Last Updated on July 28, 2019 by Marie Benz MD FAAD