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

BMC Medical Informatics and Decision Making

Research Article

Altamiro Manuel Rodrigues da Costa Pereira¹  Cristina Maria Nogueira da Costa Santos¹  Luís Filipe Ribeiro de Azevedo¹  Andreia Sofia da Costa Teixeira²  Luísa Maria Barbosa Sá³  Alberto Augusto Oliveira Pinto Hespanhol³  Paulo Alexandre Azevedo Pereira Santos³  Maria Luciana Gomes Domingues do Couto³  Carlos Manuel Silva Martins⁴ 

[1] Centre for Research in Health Technologies and Information Systems (CINTESIS), Information Sciences and Decision on Health Department (CIDES), Faculty of Medicine, University of Porto, Porto, Portugal;DCC- Faculty of Sciences, SQIC at Institute of Telecommunications, University of Porto, Porto, Portugal;Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal;Family Medicine Unit, Social Sciences and Health Department of the Faculty of Medicine of Porto, Porto, Portugal;Unidade de Medicina Geral e Familiar, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal;

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

DOI  :  10.1186/s12911-017-0416-6

 received in 2016-04-29, accepted in 2017-02-09,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsParticipants 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tests.The intervention group had a modified software with a basic shortcut menu changes, where some tests were withdrawn or added, and with the implementation of an evidence-based decision support based on United States Preventive Services Task Force (USPSTF) recommendations.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group was compared with usual software (control group).The outcomes were the number of tests prescribed from those: withdrawn from the basic menu; added to the basic menu; marked with green dots (USPSTF’s grade A and B); and marked with red dots (USPSTF’s grade D).ResultsComparing the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).ConclusionsRemoving 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 registrationISRCTN45427977, May 1st 2014 (retrospectively registered).

【 授权许可】

CC BY   
© The Author(s). 2017