Improving laboratory usage: a review

Postgraduate Medical Journal - Tập 64 Số 750 - Trang 283-289 - 1988
David W. Young1
1Dudley Road Hospital , Birmingham B18 7QH , UK

Tóm tắt

Summary 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.

Từ khóa


Tài liệu tham khảo

Dixon, R.H. & Laszlo, J. Utilisation of clinical chemistry services by medical house staff. Arch Intern Med 1974, 134: 1064-1067.

Eisenberg, J.M., Williams, S.V., Gardner, L. Viale, R. & Smits, H. Computer based audit to detect and correct over-utilisation of laboratory tests. Med Care 1977, 15: 915-921.

Schroeder, S.A. & Martin, A.R. Will change in how physicians order tests reduce medical costs. Ann Intern Med 1981, 94: 534-535.

Grivell, A.R., Forgie, H.J., Fraser, C.G. & Berry, M.N. League table of biochemical laboratory costs. Med J Aust 1982, 2: 326-328.

Schroeder, S.A., Myers, L.P., McPhee, S.J. et al. The failure of physician education as a cost containment strategy. JAMA 1984, 252: 225-230.

Fowkes, F.G.R., Evans, K.T., Hartley, G. et al. Multicentre trial of four strategies to reduce use of a radiology test. Lancet 1986, i: 367-369.

Myers, L.P. & Schroeder, S.A. Physicians use of services for the hospitalised patients: a review, with implications for cost containment. Milbank Mem Fund Q 1981, 59: 481-507.

Stilwell, J., Young, D.W. & Cunington, A. Evaluation of lab tests in hospitals. Ann Clin Biochem 1980, 17: 281-286.

Fraser, C.G. & Woodford, F.P. Strategies to modify the test-requesting patterns of clinicians. Ann Clin Biochem 1987, 24: 223-231.

Health Service Costing Returns (year ending 31st March 1986). DHSS, London, 1985, pp 15.

Harper, D.R. Disease cost in a surgical ward. Br Med J 1979, 1: 647-649.

Young, D.W. Costs and Decisions. J R Coll Physicians 1983, 17: 86-87.

Eisenberg, J.M. & Williams, S.V. Cost containment and change in physicians practice behaviour. JAMA 1981, 246: 2195-2201.

Grossman, R.M. A review of physician costcontainment strategies for laboratory testing. Med Care 1983, 21: 783-801.

Eisenberg, J.M. Physician utilisation: the state of research about physicians' practice patterns. Med Care 1985, 23: 461-483.

Wong, E.T., McCarron, M.M. & Shaw, S.T. Ordering of laboratory tests in a teaching hospital. JAMA 1983, 249: 3076-3080.

Wong, E.T. & Lincoln, T.L. Ready! Fire!... Aim! an enquiry into laboratory test ordering. JAMA 1983, 250, 2510-2513.

Resource Management (Management Budgeting) in Health Authorities. HN(86)23, DHSS, London, 1986.

Golden, W.E., Pappas, A.A. & Lavender, C. Financial unbundling reduces outpatient laboratory use. Arch Intern Med 1987, 147: 1045-1048.

Griner, P.F., The Medical House Staff, Strong Memorial Hospital. Use of laboratory tests in a teaching hospital: longterm trends. Ann Intern Med 1979, 90: 243-248.

Applegate, W.B., Bennet, M.D., Chiltern, L., Skipper, B.J. & White, R.E. Impact of a cost containment educational programme on house staff ambulatory clinical changes. Med Care 1983, 21: 486-496.

Eisenberg, S.M. An educational program to modify use by house staff. J Med Educ 1977, 52, 578-58 1.

Skipper, J.K., Smith, G., Mulligan, S.L. & Gerg, M.L. Physician knowledge of cost. The case of diagnostic tests. Inquiry 1976, 13: 194-198.

Everett, G.D., de Blois, S., Chang Pao-Fang & Holets, T. Effect of cost education, cost audit, faculty chart review on the use of laboratory services. Arch Intern Med 1983, 143: 942-944.

Marton, K.I., Tul, V. & Sox, H.C. Modifying testordering behaviour in the out-patient medical clinic. Arch Intern Med 1985, 145: 816-821.

Lawrence, R.S. The role of physician education in cost control. In: Carels, E.J., Neuhauser, D. & Stason, W.B. (eds) The Physician and Cost Control. Oelgeschlager, Gunn and Hain, Cambridge, Mass, 1980, ch. 9.

Spitzer, W.O. Educational determinants of para clinical investigation by physicians in teaching hospitals. In: Carels, E.J., Neuhauser, D. & Stason W.B. (eds) The Physician and Cost Control. Oelgeschlager, Gunn and Hain, Cambridge, Mass., 1980, ch. 8.

Young, D.W. A survey of decision aids for clinicians. Br Med J 1982, 285: 1332-1336.

Young, D.W. An aid to reducing unnecessary investigations. Br Med J 1980, 281: 1610-1611.

Thomas, J.C., Moore, A., Qualls, P.H. & Qualls, P.E. The effect on cost of medical care for patients treated with an automatic clinical audit system. J Med Syst 1983, 7: 307-313.

McDonald, C.J. Use of a computer to detect and respond to clinical events: its effect on clinician behaviour. Ann Intern Med 1976, 84: 162-167.

Fowkes, F.G.R., Hall, R., Jones, J.J. et al. Trial of strategy for reducing the use of laboratory tests. Br Med J 1986, 292: 883-885.

Martin, A.R., Wolf, M.A., Thiboldeau, L.A., Dzau, V. & Braunwald, E. A trial of two strategies to modify the test ordering behaviour of medical residents. N Engl J Med 1980, 303: 1330-1336.

Neuhauser, D. Variations in inpatient care. In: Carels, E.J., Neuhauser, D. & Stason, W.B. (eds) The Physician and Cost Control. Oelgeschlager, Gunn and Hain, Cambridge, Mass., 1980, ch. 5.

Schroeder, S.A., Kenders, K., Cooper, J.K. & Piemme, T.E. Use of laboratory tests and pharmaceuticals: variation among physicians and effects of cost audit on subsequent use. JAMA 1973, 225: 969973.

Cohen, D.J., Jones, P., Tittenberg, B. & Neuhauser, D. Does cost information availability reduce physician test usage. Med Care 1982, 20: 280-292.

Everett, G.D. Impact of supervision by medical teachers and in-patient test control programmes on the out-patient test utilisation of residents. Med Educ 1985, 19: 138-142.

Everett, G.D. Laboratory utilisation by house staff: the importance of attitude. Clin Res 1982, 30: 640a.

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, 13: 397-407.

Schroeder, S.A. Variations in physicians' practice patterns: a review of medical cost implications. In: Carels, E.J., Neuhauser, D., & Stason, W.B. (eds) The Physician and Cost Control. Oelgeschlager, Gunn and Hain, Cambridge, Mass., 1980, ch. 2.