Multimodal Lab Test Strategy for Health Care Utilization

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

251817 Participants Needed

Trial Summary

What is the purpose of this trial?

Laboratory test overuse occurs when tests are ordered repetitively, without due consideration of impact on clinical status. Repetitive inpatient lab testing often provides limited value for patient outcomes while increasing healthcare costs, patient discomfort, and unnecessary transfusions and prolonging hospitalizations. The research study aims to reduce laboratory test overuse in hospitals through implementation of a comprehensive, multi-disciplinary, and multi-faceted intervention bundle that includes audit and feedback reports, clinician education, clinical decision support tool, and patient infographics across 14 hospitals in Alberta.

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 data supports the effectiveness of the treatment Re-Purposing the Ordering of 'Routine' Laboratory Tests in Hospitalized Medical Patients (RePORT Study)?

Research shows that reducing unnecessary laboratory tests can lower healthcare costs and improve patient outcomes by avoiding unnecessary medical interventions. Studies have found that a significant portion of ordered tests are not clinically necessary, suggesting that a more rational approach to test ordering can be beneficial. ^{1 2 3 4 5}

Is the Multimodal Lab Test Strategy for Health Care Utilization safe for humans?

The studies reviewed focus on reducing unnecessary lab tests in hospitals, which can help avoid potential harm from overtesting. They suggest that interventions to limit routine tests are generally safe and aim to improve patient care by reducing waste and unnecessary procedures. ^{4 6 7 8 9}

How does the Multimodal Lab Test Strategy treatment differ from other treatments for health care utilization?

The Multimodal Lab Test Strategy is unique because it focuses on optimizing the use of laboratory tests to reduce unnecessary testing and associated costs, rather than directly treating a medical condition. This approach aims to improve the efficiency of health care by minimizing repetitive and low-value lab tests, which is different from traditional treatments that typically involve medications or procedures targeting specific health issues. ^{3 7 10 11 12}

Research Team

Anshula Ambasta, Doctor

Principal Investigator

University of Calgary

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

References

1. Romania pubmed.ncbi.nlm.nih.gov

Clinical chemistry laboratory test overuse in a cardiology clinic: a single-center study. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study. [2021]

3. Canada pubmed.ncbi.nlm.nih.gov

Diagnostic testing in family practice. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Impact of an education and multilevel social comparison-based intervention bundle on use of routine blood tests in hospitalised patients at an academic tertiary care hospital: a controlled pre-intervention post-intervention study. [2021]

5. Italy pubmed.ncbi.nlm.nih.gov

Improving laboratory test ordering can reduce costs in surgical wards. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Impact of Clinical Specialty on Attitudes Regarding Overuse of Inpatient Laboratory Testing. [2019]

7. Korea (South) pubmed.ncbi.nlm.nih.gov

Reducing Test Utilization in Hospital Settings: A Narrative Review. [2018]

8. England pubmed.ncbi.nlm.nih.gov

Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Identifying low value pathology test ordering in hospitalised patients: a retrospective cohort study across two hospitals. [2020]

10. England 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. [2023]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Exploring Lab Tests Over Utilization Patterns Using Health Analytics Methods. [2018]

12. United States pubmed.ncbi.nlm.nih.gov

Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing. [2022]