Curtailing laboratory test ordering in a managed care setting through redesign of a computerized order form

Abstract

Objective: To increase appropriate use of blood tests for folic acid and vitamin B" ordered by primary care physicians in a managed care organization in Israel through redesign of a computerized order form. Study Design: Pre-post intervention. Methods: A new version of the computerized order form was launched. Utilization patterns were calculated for tests of vitamin B12, folic acid, and ferritin, which were previously grouped together. Concomitant utilization patterns for tests of hemoglobin and iron were evaluated as controls. Results: Tests ordered for the 3 targets decreased by 31% to 41% relative to the preintervention month, with a further decrease to 36% to 53% the following month. Negligible changes in utilization patterns were observed for the controls (-2% to 3%) during the postintervention period. Conclusions: Simple restructuring of a computerized order form significantly reduced the number of laboratory tests suspected of being unnecessary or redundant. When overutilization of laboratory resources is suspected, managers should evaluate the efficiency of the organization's current ordering procedures before implementing resource-intensive interventions.