Clinical StudiesA randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests☆
Section snippets
Study site
Brigham and Women’s Hospital is a 720-bed tertiary care hospital that maintains a personal computer, local-area network-based, integrated hospital information system to provide clinical, administrative, and financial functions 16, 17. Computerized physician order entry was implemented on the medical service in May 1993 and on the surgical service in September 1993 for all patient orders 18, 19. During the study, physicians could order tests using physician order entry or send specimens directly
Results
During the study period, there were 11,586 admissions to the hospital, 5,700 of which were randomly assigned to the intervention group and 5,886 of which were assigned to the control group (Table 2). Age and gender were similar in these two groups. Among these admissions, there were 5,059 that included at least one of the tests studied (2,478 in the intervention group, and 2,581 in the control group). In total, the intervention group had 13,425 study tests versus 13,847 for the control group,
Discussion
We found that giving reminders for redundant tests was effective when it was possible to provide them and that cancellation of redundant tests appeared to result in little or no loss of clinical information. However, the effect of the intervention was limited, because 56% of redundant tests that were performed did not have a corresponding computer order and because 50% of the tests with a computer order were not screened for redundancy because they were ordered as part of an order set.
The high
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2018, Artificial Intelligence in MedicineCitation Excerpt :A limitation of our study design is that we cannot distinguish between the initial intention of the ordering physician and the change of his decision caused by the CDSS recommendations. We are aware of one single study [24] which was effectively able to record both the physicians intention and his final decision within the study design. Some previous studies, starting with the pioneering one by Eisenberg et al. [25], demonstrated no effect of a CDSS on the prevention of unnecessary lab tests.
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Supported by Grant RO1 HS08927 from the Agency for Health Care Policy and Research.