A Trial of Two Strategies to Modify the Test-Ordering Behavior of Medical Residents

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Abstract
We studied two methods to reduce the ordering of laboratory and radiologic tests by medical residents in their first postgraduate year. Dividing the residents into three groups, we compared the effect of concurrent chart review and discussion in one group with the effect of a moderate financial incentive for limited ordering of tests in a second group. The third group of residents served as a concurrent control, and data on the testing patterns of residents at the same hospital during the year before the study provided a retrospective control. After a base-line period of observation, all residents, including those in the control group, had statistically significant reductions in laboratory testing during the intervention period of the study. However, chart review produced the most dramatic (47 per cent) and sustained reductions. The financial incentive seemed to be of no value when the testing pattern of this group was compared with that of the control group. No significant effect on radiologic testing was achieved in any of the groups. (N Engl J Med. 1980; 303:1330–6.)

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