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Invited Commentary
September 23, 2013

Can Physicians Change Their Laboratory Test Ordering Behavior?A New Look at an Old Issue

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2013;173(17):1655-1656. doi:10.1001/jamainternmed.2013.7495

Although there has been lingering concern about rising expenditures for medical care for at least 4 decades, the issue has become more prominent recently, driven by distress about the federal deficit, the opportunity costs of excessive medical expenditures, and the reality that the levels of spending in the United States do not generate comparable health benefits. One way to contain medical expenditures is to change how physicians order costly medical resources such as hospitalizations, laboratory tests, imaging, and pharmaceuticals. Strategies to do this include changing financial incentives, education, peer review, and feedback.1 The reality that costs can be selectively reduced without harming outcomes is buttressed by data showing wide variations in care among physicians practicing in the same setting2 and across regions.3 Fogarty and colleagues4 tested whether education about the price of a laboratory test that is of limited diagnostic and therapeutic value (C-reactive protein [CRP] assay) could change the frequency of test ordering at a United Kingdom (UK) hospital when compared with a control medical center. The answer: test ordering was significantly reduced (by 32% compared with baseline) in the in-patient setting of the experimental hospital compared with the control institution, but not in the outpatient setting. The authors assessed whether compensatory-increased ordering occurred in another test measuring inflammation—the complete blood cell count. It did not.

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