Assessment of decision support for blood test ordering in primary care. a randomized trial.
BACKGROUND
Different methods for changing blood test-ordering behavior in primary care have been proven effective. However, randomized trials comparing these methods are lacking.


OBJECTIVE
To compare the effect of two versions of BloodLink, a computer-based clinical decision support system, on blood test ordering among general practitioners.


METHODS
Randomized trial.


METHODS
44 practices of general practitioners in the region of Delft, the Netherlands.


METHODS
60 general practitioners in 44 practices who used computer-based patient records in their practices.


METHODS
After stratification by solo practices and group practices, practices were randomly assigned to use BloodLink-Restricted, which initially displays a reduced list of tests, or BloodLink-Guideline, which is based on the guidelines of the Dutch College of General Practitioners.


METHODS
Average number of blood tests ordered per order form per practice.


RESULTS
General practitioners who used BloodLink-Guideline requested 20% fewer tests on average than did practitioners who used BloodLink-Restricted (mean [+/-SD], 5.5 +/- 0.9 tests vs. 6.9 +/- 1.6 tests, respectively; P = 0.003, Mann-Whitney test).


CONCLUSIONS
Decision support based on guidelines is more effective in changing blood test-ordering behavior than is decision support based on initially displaying a limited number of tests. Guideline-driven decision support systems can be effective in reducing the number of laboratory tests ordered by primary care practitioners.
van Wijk
M A
MA
Department of Medical Informatics, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands. wijk@mi.fgg.eur.nl
van der Lei
J
J
Mosseveld
M
M
Bohnen
A M
AM
van Bemmel
J H
JH
D003661:Decision Support Techniques; D005194:Family Practice; D005260:Female; D005568:Forms and Records Control; D019983:Guideline Adherence; D006403:Hematologic Tests / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D009426:Netherlands; D016012:Poisson Distribution; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D012984:Software; D018709:Statistics, Nonparametric