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30% of lab tests overused, 30% underused

By Neel Shah Moderator | 19 Nov, 2013

In another indictment of the value gap in American healthcare, researchers at Beth Israel Deaconess Medical Center in Boston analyzed 1.6 million blood tests and found that only one third hit the mark. By contrast, one third are either overused or underused.

Why do we misfire so often?

What does everyone think of the study conclusions? Are they fair?

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A/Prof. Terry HANNAN Replied at 2:50 PM, 19 Nov 2013

Neel, I believe this reporting is close to being accurate. In the attached slide set you will note the Canadian and UK overuse/under/use/inappropriate use of resources. Terry

Attached resource:

Jordan Harmon Moderator Replied at 8:31 PM, 19 Nov 2013

This study pinpoints the issue well. With the balance of over-utilization/under-utilization so difficult, resident Ming Zhi describes how difficult it can be, "Do my patients really need another set of tests? Do they really need another needle stick? Is there a test they may need that I left out?”

Not only do most residents face these same questions with little guidance, most attending physicians, patients, and managers are also confused about what the best test for the money might be.

A/Prof. Terry HANNAN Replied at 9:01 PM, 19 Nov 2013

Jordan, which is why the following three publications are so important on this topic.
1. Johns RJ, Blum BI. The use of clinical information systems to control cost as well as to improve care. Trans Am Clin Climatol Assoc. 1979;90:140-52. Epub 1979/01/01.
2. Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993;269(3):379-83. Epub 1993/01/20.
3. Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990;322(21):1499-504. Epub 1990/05/24.

I have also addressed this and reasons why in my recent publication (I think I have already posted the reference) Hannan TJ, Celia C. Are doctors the structural weakness in the e-health building? Intern Med J. 2013;43(10):1155-64. Epub 2013/10/19.
I hope this helps. terry

Marie Connelly Replied at 4:40 PM, 20 Nov 2013

Thanks so much for posting this, Neel! And many thanks, Terry, for sharing your presentation slides - fascinating to see how these issues are playing out in health care systems around the world.

I'm quite surprised to see that only 30% of lab tests are hitting the mark, so to speak. I wonder what some of the possible solutions here are? Is it health IT solutions that indicate which tests might be most appropriate given the diagnostic situation? Or just greater awareness amongst clinicians in general? While I think patient advocacy can play a huge role in keeping care affordable, this is one area of controlling costs where I think it becomes particularly challenging - how do you tell your clinician you don't need certain tests? While I have seen some research and discussion online amongst patients about having labs done at less expensive locations, I'm not sure how widespread that is, and certainly many patients will have limited options, even if they're on the lookout for them.

This Community is Archived.

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