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Comment & Response
Less Is More
May 2018

Potential Methods to Reduce Unnecessary Use of Laboratory Testing—Reply

Author Affiliations
  • 1Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin
JAMA Intern Med. 2018;178(5):729-730. doi:10.1001/jamainternmed.2018.1213

In Reply Our recent study1 found that patients with common medical conditions have many more laboratory tests drawn at teaching hospitals compared with patients at nonteaching hospitals, even after considering illness severity and performing a number of sensitivity analyses. While our claims-based study could not determine the “appropriateness” of laboratory tests, the pattern and lack of correlation between hospital-level mean number of laboratory tests per day and mortality rates suggests overuse at teaching hospitals. There are many reasons for laboratory test overuse at teaching hospitals, though as Boice points out, organizational culture within teaching hospitals likely plays a prominent role. We have previously written about how the current prevailing medical culture contributes to overtesting, overtreatment, and health care waste, and how health systems can shift toward fostering a culture of high-value care.2 We also agree with Boice that faculty attending physicians largely shape the culture in teaching hospitals.

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