Preventing overuse of laboratory diagnostics: a case study into diagnosing anaemia in Dutch general practice

Background More information is often thought to improve medical decision-making, which may lead to test overuse. This study assesses which out of 15 laboratory tests contribute to diagnosing the underlying cause of anaemia by general practitioners (GPs) and determines a potentially more efficient su...

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Published in:BMC medical informatics and decision making Vol. 20; no. 1; pp. 178 - 11
Main Authors: Kip, Michelle M. A., Oonk, Martijn L. J., Levin, Mark-David, Schop, Annemarie, Bindels, Patrick J. E., Kusters, Ron, Koffijberg, Hendrik
Format: Journal Article
Language:English
Published: London BioMed Central 31.07.2020
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Age
Analysis
Anemia
Anemia - diagnosis
Case reports
Case studies
Clinical decision making
Data analysis, statistical
Decision making
Diagnoses and laboratory examinations
Diagnosis
Epidermal growth factor receptors
Family medicine
Family physicians
Ferritin
Ferritins
Folic acid
Gender
General Practice
General practitioners
Health Informatics
Hemoglobin
Hemoglobins
Humans
Information Systems and Communication Service
knowledge support systems
Laboratories
Laboratory tests
Leukocytes
Management of Computing and Information Systems
Medical diagnosis
Medicine
Medicine & Public Health
Optimal testing
Overuse
Patients
Prevention
Questionnaires
Research Article
Reticulocytes
Statistical analysis
theory
Transferrin
Transferrins
General practice
Optimal testing
Diagnoses and laboratory examinations
Anemia
Data analysis, statistical
Overuse
ISSN:1472-6947, 1472-6947
Online Access:Get full text
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Summary:Background More information is often thought to improve medical decision-making, which may lead to test overuse. This study assesses which out of 15 laboratory tests contribute to diagnosing the underlying cause of anaemia by general practitioners (GPs) and determines a potentially more efficient subset of tests for setting the correct diagnosis. Methods Logistic regression was performed to determine the impact of individual tests on the (correct) diagnosis. The statistically optimal test subset for diagnosing a (correct) underlying cause of anaemia by GPs was determined using data from a previous survey including cases of real-world anaemia patients. Results Only 9 (60%) of the laboratory tests, and patient age, contributed significantly to the GPs’ ability to diagnose an underlying cause of anaemia (CRP, ESR, ferritin, folic acid, haemoglobin, leukocytes, eGFR/MDRD, reticulocytes and serum iron). Diagnosing the correct underlying cause may require just five (33%) tests (CRP, ferritin, folic acid, MCV and transferrin), and patient age. Conclusions In diagnosing the underlying cause of anaemia a subset of five tests has most added value. The real-world impact of using only this subset should be further investigated. As illustrated in this case study, a statistical approach to assessing the added value of tests may reduce test overuse.
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ISSN:1472-6947
1472-6947
DOI:10.1186/s12911-020-01198-8