Curtailing laboratory test ordering in a managed care setting through redesign of a computerized order form.
OBJECTIVE
To increase appropriate use of blood tests for folic acid and vitamin B12 ordered by primary care physicians in a managed care organization in Israel through redesign of a computerized order form.


METHODS
Pre-post intervention.


METHODS
A new version of the computerized order form was launched. Utilization patterns were calculated for tests of vitamin B12, folic acid, and ferritin, which were previously grouped together. Concomitant utilization patterns for tests of hemoglobin and iron were evaluated as controls.


RESULTS
Tests ordered for the 3 targets decreased by 31% to 41% relative to the preintervention month, with a further decrease to 36% to 53% the following month. Negligible changes in utilization patterns were observed for the controls (-2% to 3%) during the postintervention period.


CONCLUSIONS
Simple restructuring of a computerized order form significantly reduced the number of laboratory tests suspected of being unnecessary or redundant. When overutilization of laboratory resources is suspected, managers should evaluate the efficiency of the organization's current ordering procedures before implementing resource-intensive interventions.
Kahan
Natan R
NR
Leumit Health Fund, PO Box 20083, Tel Aviv, 64738 Israel. natan.kahan@mail.huji.ac.il
Waitman
Dan-Andrei
DA
Vardy
Daniel A
DA
D016022:Case-Control Studies; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D005293:Ferritins / Q000097:blood*; D005492:Folic Acid / Q000097:blood*; D006801:Humans; D007557:Israel; D008329:Managed Care Programs / Q000458:organization & administration*; D016347:Medical Records Systems, Computerized; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review; D014805:Vitamin B 12 / Q000097:blood*
D005293:Ferritins; D005492:Folic Acid; D014805:Vitamin B 12