title: Effect of provider continuity on test repetition.
abstract: BACKGROUND
  Provider continuity (PC) occurs when a patient is treated by the same physician over time. A perceived benefit of PC is decreased test repetition. Repeat tests make up a significant proportion of overall laboratory utilization. This study determined whether test repetition increases when PC decreases.
  
  
  METHODS
  Cohort study of adults in eastern Ontario, Canada between September 1999 and September 2000 using population-based clinical databases. The primary study outcome was the probability that 7 common laboratory tests (hemoglobin, sodium, creatinine, thyrotropin, total cholesterol, ferritin, and hemoglobin A1C) were repeated at physician visits subsequent to the index test. We determined whether the probability of test repetition changed if the follow-up physician ordered the index test. We adjusted for multiple factors regarding the patient (age, sex, days in hospital, and number of physician visits in previous year), index test (normality and location), follow-up visit (location and time from index test), and follow-up physician (age and specialty).
  
  
  RESULTS
  The study included 881,353 patients, 1,419,438 index laboratory tests, and 7,622,938 follow-up physician visits. After adjusting for other important factors, we found that tests were significantly more likely to be repeated if the follow-up physician ordered the index test (adjusted odds ratio range 2.5-5.9). This association was consistent in most subgroups.
  
  
  CONCLUSIONS
  For these common laboratory investigations, PC was associated with increased, not decreased, test repetition. This suggests that increased PC alone will likely not decrease test utilization.
authors.affiliation: Network of Eastern Ontario Medical Laboratories (NEO-MeL), Ottawa, ONT Canada. carlv@ohri.ca
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
authors.forename: Geta
authors.initials: G
authors.lastname: Cernat
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
mesh_terms: D000328:Adult; D000367:Age Factors; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003266:Continuity of Patient Care; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011336:Probability; D012737:Sex Factors