A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests
A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests
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DOI：
10.1016/s0002-9343(98)00410-0
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发表时间：
1999-02-01
影响因子：
5.9
通讯作者：
Tanasijevic, M
中科院分区：
文献类型：
--
作者：
Bates, DW;Kuperman, GJ;Tanasijevic, M
目的：确定向医生提供关于明显多余的临床实验室测试的计算机提醒的影响。 主题和方法：我们进行了一项前瞻性随机对照试验，纳入了一家大型教学医院的所有住院患者，为期 15 周。干预措施包括在安排测试时进行计算机提醒，但这似乎是多余的。主要结果指标是被取消的临床实验室订单的比例和实际进行的测试的比例。 结果：在研究期间，干预组（n = 5,700 名患者）和对照组（n = 5,886 名患者）订购的 77,609 项研究测试中，有 939 项明显多余的实验室测试。在干预组中，69%（437 次中的 300 次）的测试因提醒而被取消。根据图表审查，在 137 项超控中，41% 似乎是合理的。在对照组中，进行了 51% 的有序冗余测试，而在干预组中，仅进行了 27% 的有序冗余测试（P < 0.001）。然而，预计每年节省的实验室费用仅为 35,000 美元。发生这种情况的原因是，执行的冗余测试中只有 44% 有计算机订单，因为只有一半的计算机订单经过了冗余筛选，而且几乎三分之一的提醒被覆盖。结论：关于明显冗余的实验室测试订单的提醒在交付时是有效的。但整体效果有限，因为很多测试是在没有相应的计算机指令的情况下进行的，而且很多指令没有进行冗余筛选。美国医学杂志。 1999；106：144-150。 (C) 1999 年，Excerpta Medica, Inc.
PURPOSE: To determine the impact of giving physicians computerized reminders about apparently redundant clinical laboratory tests.SUBJECTS AND METHODS: We performed a prospective randomized controlled trial that included all inpatients at a large teaching hospital during a 15-week period. The intervention consisted of computerized reminders at the time a test was ordered that appeared to be redundant. Main outcome measures were the proportions of clinical laboratory orders that were canceled and the proportion of the tests that were actually performed.RESULTS: During the study period, there were 939 apparently redundant laboratory tests among the 77,609 study tests that were ordered among the intervention (n = 5,700 patients) and control(n = 5,886 patients) groups. In the intervention group, 69% (300 of 437) of tests were canceled in response to reminders. Of 137 overrides, 41% appeared to be justified based on chart review. In the control group, 51% of ordered redundant tests were performed, whereas in the intervention group only 27% of ordered redundant tests were performed (P < 0.001). However, the estimated annual savings in laboratory charges was only $35,000. This occurred because only 44% of redundant tests performed had computer orders, because only half the computer orders were screened for redundancy, and because almost one-third of the reminders were overridden.CONCLUSIONS: Reminders about orders for apparently redundant laboratory tests were effective when delivered. However, the overall effect was limited because many tests were performed without corresponding computer orders, and many orders were not screened for redundancy. Am J Med. 1999;106: 144-150. (C) 1999 by Excerpta Medica, Inc.