Multimodal Lab Test Strategy for Health Care Utilization

Not currently recruiting at 1 trial location

Overseen By Surakshya Pokharel

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Calgary

Disqualifiers: Outside Alberta, Non-medical units, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to reduce unnecessary lab tests in hospitals to improve patient care and cut healthcare costs. It achieves this by providing doctors with better tools and information, such as feedback reports and educational materials, to make more informed test-ordering decisions. Participants may include patients or healthcare providers in adult hospitals in Alberta, excluding those in ICU, surgical, pediatric, or obstetric units. The trial consists of two phases: one with the new tools and one without, to compare the results. As an unphased trial, this study allows participants to contribute to innovative healthcare improvements that could benefit many.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this intervention is safe for reducing lab test overuse?

Research has shown that the study focuses on reducing unnecessary lab tests in hospitals by changing how these tests are ordered, rather than introducing a new drug or device. Consequently, there are no typical safety concerns such as side effects. The study involves educating healthcare providers and using decision tools to minimize repeated testing. It aims to improve hospital procedures rather than directly impact patients' health with new treatments. Therefore, this study poses no direct safety risks to patients. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it aims to revolutionize how routine lab tests are ordered for hospitalized patients. Unlike the current approach, which often involves ordering tests based on habit rather than necessity, this new strategy seeks to optimize test ordering to improve patient care and reduce unnecessary healthcare costs. By implementing a multimodal intervention, this trial could lead to more personalized and efficient use of lab tests, potentially setting a new standard for hospital care. If successful, this approach might enhance patient outcomes while streamlining hospital resources.

What evidence suggests that this multimodal intervention is effective for reducing laboratory test overuse?

This trial will compare the effectiveness of a multimodal intervention strategy to reduce the overuse of routine lab tests in hospitals. Research has shown that combining different methods can effectively cut down on unnecessary tests. Specifically, studies have found a 14% drop in unnecessary tests and related costs, along with a 15% decrease in the number of tests ordered. These methods include educating doctors, providing feedback, and using decision-support tools. The aim is to ensure that only necessary tests are conducted, improving patient care and reducing discomfort. Participants in this trial will join either the intervention period, where these strategies are implemented, or the control period, where standard practices continue. ^{1 2 3 5 6}

Who Is on the Research Team?

Anshula Ambasta, Doctor

Principal Investigator

University of Calgary

Are You a Good Fit for This Trial?

This trial is for patients and healthcare providers in adult medical and hospitalist units within participating hospitals in Alberta and British Columbia. It excludes those outside these provinces, non-enrolled hospitals, or units like ICU, surgical, pediatric, or obstetrical.

Inclusion Criteria

All participants (patients and healthcare providers) within enrolled adult hospitals in Alberta of medical and hospitalist units during study period

Exclusion Criteria

Non-medical units (e.g. ICU, surgical, pediatric, obstetrical units)

Outside of the above-mentioned province

Hospitals not enrolled

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Control Period

Hospital clusters are not receiving the intervention during this period

9 months

Intervention Period

Hospital clusters receive the multimodal intervention to reduce laboratory test overuse

9 months

Follow-up

Participants are monitored for safety and effectiveness after the intervention

30 days post discharge

What Are the Treatments Tested in This Trial?

Interventions

• Re-Purposing the Ordering of 'Routine' Laboratory Tests in Hospitalized Medical Patients (RePORT Study)

Trial Overview The study tests a multimodal intervention to reduce unnecessary lab testing in hospitalized patients. This includes education for clinicians, audit reports on test ordering habits, system changes to support better decision-making, and patient infographics.

How Is the Trial Designed?

Group I: Exposed to intervention (intervention period) Experimental Treatment 4 Interventions

This is the time period of the study where hospital clusters are receiving the multimodal intervention.

Group II: Unexposed to intervention (control period) Active Control 1 Intervention

This is the time period of the study where hospital clusters are not receiving the intervention

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials

827

Recruited

902,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Alberta Health services

Collaborator

Trials

168

Recruited

658,000+

University of British Columbia

Collaborator

Trials

1,506

Recruited

2,528,000+

Published Research Related to This Trial

A review of 84 studies found that various interventions, including education and computerized provider order entry, can effectively reduce unnecessary laboratory testing in hospital settings, with nearly all studies reporting a decrease in test order volume.

However, the long-term sustainability of these interventions is uncertain, and only a few studies assessed their impact on patient-related clinical outcomes, highlighting the need for more rigorous, controlled trials to determine the most effective strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing Test Utilization in Hospital Settings: A Narrative Review. Bindraban, RS., Ten Berg, MJ., Naaktgeboren, CA., et al.[2018]

A multifaceted intervention bundle, including educational tools and peer discussions, led to a 14% reduction in routine laboratory tests ordered per patient-day among 125,854 patient-days studied, resulting in significant cost savings.

The intervention did not negatively impact patient safety, indicating that reducing unnecessary lab tests can be done safely without compromising care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Repurposing the Ordering of Routine Laboratory Tests in Hospitalised Medical Patients (RePORT): results of a cluster randomised stepped-wedge quality improvement study. Ambasta, A., Omodon, O., Herring, A., et al.[2023]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38956637/

Re-Purposing the Ordering of Routine Laboratory Tests in ... This study aims to reduce lab test overuse in hospitals using a multicomponent intervention bundle, evaluated via a stepped-wedge cluster ...

2. implementationscience.biomedcentral.com implementationscience.biomedcentral.com/articles/10.1186/s13012-024-01376-6

Re-Purposing the Ordering of Routine Laboratory Tests in ... Based on administrative data, we estimate a mean of three target laboratory test orders per patient at baseline, and an average of 100 patients ...

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/37164639/

Repurposing the Ordering of Routine Laboratory Tests in ... The study aimed to reduce routine lab tests using education and social comparison. It resulted in a 14% reduction in tests and costs, and a 15% ...

4. qualitysafety-bmj-com.bibliotheek.ehb.be qualitysafety-bmj-com.bibliotheek.ehb.be/content/qhc/32/9/517.full.pdf

Repurposing the Ordering of Routine Laboratory Tests in ... Our objective was to evaluate an intervention bundle to reduce repetitive use of routine laboratory testing in hospitalised patients. Methods We used a stepped- ...

5. researchgate.net researchgate.net/publication/381921249_Re-Purposing_the_Ordering_of_Routine_Laboratory_Tests_in_Hospitalized_Medical_Patients_RePORT_protocol_for_a_multicenter_stepped-wedge_cluster_randomised_trial_to_evaluate_the_impact_of_a_multicompone

Re-Purposing the Ordering of Routine Laboratory Tests ... The study spanned October 2020–June 2021, divided into control, feasibility testing, intervention and a follow-up period. The primary outcomes ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT06119464

Re-Purposing the Ordering of 'Routine' Laboratory Tests in ... Study Plan ; Proportion of hospital patient lab-free days, Number of hospital patient-days not associated with laboratory blood draws, 1 year 9 months.