title: Long-term impact of a restrictive laboratory test ordering form on tumor marker prescriptions.
abstract: OBJECTIVE
  To evaluate the long-term impact of an intervention designed to reduce the ordering of three tumor markers frequently prescribed for gastroenterologic diseases (carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 19-9).
  
  
  METHODS
  A prospective study with time series analysis in a teaching hospital. Local clinical guidelines were developed and implemented through a new order form, designed as a reminder to the physician, restricting the ordering of laboratory tests. Ratios between the number of markers ordered and number of admissions were recorded during a 3-month period before and after intervention in the whole hospital and monthly on a 4-year period in two wards of the hospital (Department of Gastroenterology and Department of Internal Medicine). To evaluate the appropriateness of tumor marker orders, audits were performed on a sample of order forms, before and after (1 month and 2 years after) the implementation of the new order form.
  
  
  RESULTS
  The analysis of covariance showed a significant effect of the intervention in the hospital (p < .01), and in the Departments of Gastroenterology (p < .01) and Internal Medicine (p < .007). The decrease of tumor marker orders ranged from 25% (Internal Medicine Department) to 55% (whole hospital). A similar decrease was observed for the three studied markers. The appropriateness of prescriptions increased from 54.6% before to 73.6% after the implementation of the new order form, but decreased to 52.9% 2 years after intervention.
  
  
  CONCLUSIONS
  Providing a reminder to clinicians through a specific order form represents an inexpensive and easy way to implement guidelines on use of laboratory tests.
authors.affiliation: Department of Public Health and Medical Informatics, Faculté de Médecine Broussais Hôtel Dieu, Paris, France. pierre.durieux@spim.jussieu.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Durieux
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Fulla
authors.forename: Catherine-Sophie
authors.initials: CS
authors.lastname: Manet
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D004282:Documentation; D005568:Forms and Records Control; D005602:France; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000276:immunology; D006302:Health Services Research; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007118:Immunoassay / Q000706:statistics & numerical data*; D007755:Laboratories, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D013995:Time
chemical_list: D014408:Biomarkers, Tumor