An education program to reduce unnecessary laboratory tests by residents

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Abstract
What are often called “little-ticket ” items –X-rays and laboratory tests –account for 25 –30 % of all health care costs . Two such items were the focus of this study , which took place at an inner-city community health center operated by the Department of Family Medicine of Cook County Hospital and involved 20 family practice residents over a period of nine weeks . The first item was the complete blood count (CBC ) with differential , a prototype of a low-cost , high-volume test often ordered by reflex ; the second , the thyroid stimulating hormone (TSH ) test , a high-cost , low-volume test normally associated with a differential diagnosis or clinical reasoning . Through the use of a simple educational intervention based on quality of care , not cost-containment , and an audit feedback system , the authors were able to reduce significantly the rates of ordering TSH tests (p less than .0001 ) and CBCs (p = .05 ). This effect on the rates persisted five months after the intervention terminated . In addition , the percentage of TSH tests clinically indicated by explicit criteria increased significantly (p less than .001 ) during the intervention . However , this effect showed signs of diminishing five months after the intervention ended . The percentage of CBCs clinically indicated did not change significantly as a result of this intervention .

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