Appl Clin Inform 2022; 13(03): 656-664
DOI: 10.1055/a-1854-4253
Research Article

Displaying Cost and Completion Time for Reference Laboratory Test Orders—A Randomized Controlled Trial

Shohei Ikoma
1   Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Logan Pierce
2   Division of Hospital Medicine, University of California San Francisco, San Francisco, California, United States
,
Douglas S. Bell
3   Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
,
Eric M. Cheng
4   Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, United States
,
Thomas Drake
5   Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
,
Rong Guo
6   Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, United States
,
Alyssa Ziman
7   Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
› Author Affiliations

Abstract

Objectives Reduction in unnecessary services is one strategy for increasing the value of health care. Reference laboratory, or send-out, tests are associated with considerable costs. We investigated whether displaying cost and turnaround time (TAT), or time-to-result, for reference laboratory tests at the time of order entry in the electronic health record (EHR) system would impact provider ordering practices.

Methods Reference laboratory test cost and TAT data were randomized prior to the study and only displayed for the intervention group. A 24-month dataset composed of 12 months each for baseline and study periods was extracted from the clinical data mart. A difference-in-differences (DID) analysis was conducted using a linear mixed-effects model to estimate the association between the intervention and changes in test-ordering patterns.

Results In the inpatient setting, the DIDs of aggregate test-order costs and volume were not different among the control and intervention groups (p = 0.31 and p = 0.26, respectively). In the ambulatory setting, the DIDs of aggregate test-order costs and volume were not different among the control and intervention groups (p = 0.82 and p = 0.51, respectively). For both inpatient and ambulatory settings, no significant difference was observed in the DID of aggregate test-order costs and volumes calculated in respect to stratified relative cost and TAT groups (p > 0.05).

Conclusion Lack of alternative tests, test orders placed at a late step in patient management, and orders facilitated by trainees or mid-level providers may have limited the efficacy of the intervention. Our randomized study demonstrated no significant association between the display of cost or TAT display and ordering frequency.

Protection of Human and Animal Subjects

The institutional review board approved the project as exempt human subjects research study because it was viewed as a quality-improvement project.


Supplementary Material



Publication History

Received: 16 January 2022

Accepted: 11 May 2022

Accepted Manuscript online:
17 May 2022

Article published online:
06 July 2022

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