title: House Officer-Driven Reduction in Laboratory Utilization.
abstract: OBJECTIVE
  To determine whether sharing laboratory charge and personal utilization information with physicians can reduce laboratory test orders and expenditures, thereby decreasing the overutilization of laboratory testing.
  
  
  METHODS
  This was a prospective study. By querying our electronic medical records, we calculated the median laboratory charges per patient/per day (PP/PD) and median laboratory tests ordered PP/PD for the resident general internal medicine and hospitalist services. For 10 weeks, we shared this team-based information with physicians with weekly updates. We calculated total laboratory charges for the 10 most common discharge diagnoses to capture laboratory charges for entire episodes of care.
  
  
  RESULTS
  During the intervention, the mean number of laboratory tests ordered PP/PD by resident service decreased from 5.56 to 5.17 (-0.389, P <0.001); the mean charge PP/PD decreased from $488 to $461 (-$27, P < 0.001). The hospitalist service decreased the number of laboratory tests ordered PP/PD from 3.54 to 3.36 (-0.18, P = 0.77) and the mean charge PP/PD decreased from $331 to $301 (-$30, P = 0.96). The statistically significant decline in laboratory charges persisted after controlling for the 10 most common discharge diagnoses. Compared with the 3-month period before the study began, physicians in the 10-week intervention period ordered 1464 fewer laboratory tests, resulting in a $188,000 reduction in charges and a 3% to 4% reduction in utilization.
  
  
  CONCLUSIONS
  Informing physicians of the charges for laboratory tests and their personal utilization patterns can reduce the number of laboratory tests ordered and laboratory expenditures, especially for physicians in training.
authors.affiliation: From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Bernard
authors.initials: B
authors.lastname: Tawfik
authors.affiliation: From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: J B
authors.initials: JB
authors.lastname: Collins
authors.affiliation: From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: From the Department of Internal Medicine, Wake Forest School of Medicine, the Department of Biostatistical Sciences, Wake Forest Baptist Health Performance Improvement, and the Department of Biostatistics and Bioinformatics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: David P
authors.initials: DP
authors.lastname: Miller
mesh_terms: D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D057286:Electronic Health Records; D007388:Internal Medicine; D007753:Laboratories / Q000191:economics* / Q000706:statistics & numerical data*; D000069342:Medical Overuse / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D014481:United States