The Value of Laboratory Diagnostics in the Clinical Setting

In attempts to contain increasing health care costs while maintaining high quality, the concept of low-value care has gained widespread attention over recent years. This thesis specifically addresses low-value laboratory testing. First, we describe several interventions which have proven their effectiveness in reducing the burden of laboratory testing, including educational interventions, audit and feedback methods, and changes in (computerized) provider order entry systems. In the following chapters, we describe the RODEO (Reduction of Unnecessary Diagnostics through Attitude Change of the Caregivers) – project, aimed at reducing laboratory testing in the Internal Medicine department of four teaching hospitals in the Netherlands. In this project, a multifaceted intervention was carried out consisting of creating awareness through education and feedback, intensified supervision of residents, and changes in (computerized) order entry systems. Although the main interventions were similar, each clinic was given the opportunity to tailor their strategy as deemed useful in the local situation. This set of interventions was associated with a reduction in laboratory test volume in all participating departments, whereas the volume increased in comparable hospitals in the Netherlands. Studied clinical outcomes were not negatively affected. Although we were only able to investigate short-term sustainability in the RODEO project, we also describe a similar project in which we demonstrated long-term sustainability of our approach. Furthermore, using our experiences and feedback from physicians participating in the RODEO project, complemented by current literature, we present a step-by-step action plan that is appropriate for direct use to specifically decrease unnecessary laboratory testing in hospital settings.