Abstract
BackgroundInappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care.MethodsThis study was a pragmatic, cluster randomized, open-label, controlled clinical trial.SettingTwo hundred eighty general practitioners (GPs) from 72 primary care practices in Belgium.PatientsPatients aged ≥ 18 years with a laboratory test order for at least one of 17 indications: cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication.InterventionsThe CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician.MeasurementsThe primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume, and cascade activities.ResultsCDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16–0.26, p < 0.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37–10.93, p = 0.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease–0.05% increase) in possible diagnostic error.ConclusionsA CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error.Trial registrationClinicalTrials.gov Identifier: NCT02950142, registered on October 25, 2016
Highlights
Laboratory test ordering is a vital clinical procedure performed in primary care and the number of tests ordered annually is steadily increasing
Clinical decision support systems (CDSS) increased the proportion of appropriate tests by 0.21 for all tests included in the study
A CDSS in the form of order sets, integrated within the computerized physician order entry (CPOE) improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error
Summary
Laboratory test ordering is a vital clinical procedure performed in primary care and the number of tests ordered annually is steadily increasing. For 2018, spending on laboratory testing in healthcare has been valued at $ 80 billion in the USA, and since 2013, costs for laboratory spending have increased more than 15%, representing the largest increase in utilization of any outpatient procedure [1, 2]. This rise in costs is largely due to an increase in laboratory test ordering and this trend is not limited to the USA. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
