Practice guidelines to reduce testing in the hospital

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Abstract
Objective:To reduce testing among bospitalized patients using practice guidelines for any of 14 medical problems. Design:Comparison of test use before and after implementation of guidelines. The guidelines were developed by consensus panels of self-selected participating physicians. Non-participating physicians were monitored during the same periods. In addition, the two groups of physicians were evaluated similarly for their management of three medical problems for which guidelines were not developed. Setting:Acute care hospital. Patients/participants:1,638 hospitalized patients and their 79 physicians. Intervention:Implementation of practice guidelines for the care of hospitalized patients. Measurement and main results:Geometric mean charges expressed in inflation-adjusted dollars were used as measures of test use. For the intervention group, laboratory tests decreased by 20.6%, x-rays by 42.3%, and EKGs by 34.2%. All the decreases were significant (p=0.001). The non-participating physicians who were higher test users during both years of the study also achieved significant (p. Conclusions:1) A large group of physicians could be recruited in a hospital to establish practice guidelines by group consensus. 2) These self-selected physicians were willing to use the guidelines (or allow the bousestaff to use them) while caring for their patients. 3) Participating physicians were able to achieve substantial and significant reductions in testing without any demonstrable adverse effect on quality of care as measured by deaths and readmissions, and without any demonstrable shifting of resources from the inpatient to the outpatient setting of care. 4) The reductions in testing, whether caused by the guidelines or not, persisted for at least six months beyond the end of the period of implementation.