The effects of an educational meeting and subsequent computer reminders on the ordering of laboratory tests by rheumatologists: an interrupted time series analysis.
To examine the effects of an educational meeting and subsequent computer reminders on the number of ordered laboratory tests.



Using interrupted time series analysis we assessed whether trends in the number of laboratory tests ordered by rheumatologists between September 2012 and September 2015 at the Sint Maartenskliniek (the Netherlands) changed following an educational meeting (September 2013) and the introduction of computer reminders into the Computerised Physician Order Entry System (July 2014). The analyses were done for the set of tests on which both interventions had focussed (intervention tests; complement, cryoglobulins, immunoglobins, myeloma protein) and a set of control tests unrelated to the interventions (alanine transferase, anti-cyclic citrullinated peptide, C-reactive protein, creatine, haemoglobin, leukocytes, mean corpuscular volume, rheumatoid factor and thrombocytes).



At the start of the study, 101 intervention tests and 7660 control tests were ordered per month by the rheumatologists. After the educational meeting, both the level and trend of ordered intervention and control tests did not change significantly. After implementation of the reminders, the level of ordered intervention tests decreased by 85.0 tests (95%-CI -133.3 to -36.8, p<0.01), the level of control tests did not change following the introduction of reminders.



In summary, an educational meeting alone was not effective in decreasing the number of ordered intervention tests, but the combination with computer reminders did result in a large decrease of those tests. Therefore, we recommend using computer reminders in addition to education if reduction of inappropriate test use is aimed for.
Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands. n.lesuis@maartenskliniek.nl.
Nienke
N
Lesuis
Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands.
Nathan
N
den Broeder
Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands.
Nadine
N
Boers
Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands.
Ester
E
Piek
Department for Health Evidence, Biostatistics Section, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
Steven
S
Teerenstra
Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands.
Marlies
M
Hulscher
Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden.
Ronald
R
van Vollenhoven
Department of Rheumatology and Laboratory, Sint Maartenskliniek, Nijmegen, the Netherlands.
Alfons A
AA
den Broeder
D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data* / Q000639:trends; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data* / Q000639:trends; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data* / Q000639:trends; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D065186:Interrupted Time Series Analysis; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data* / Q000639:trends; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000639:trends; D011237:Predictive Value of Tests; D017010:Reminder Systems / Q000706:statistics & numerical data* / Q000639:trends; D000072140:Rheumatologists / Q000193:education* / Q000639:trends; D013997:Time Factors; D019564:Unnecessary Procedures
D015415:Biomarkers