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Assessment of Decision Support for Blood Test Ordering in Primary Care
A Randomized Trial
- Marc A.M. van Wijk, MD, PhD;
- Johan van der Lei, MD, PhD;
- Mees Mosseveld, MSc;
- Arthur M. Bohnen, MD, PhD; and
- Jan H. van Bemmel, PhD
- From Institute of Medical Informatics and Institute of Primary Care Medicine, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Abstract
Background: Different methods for changing blood test–ordering behavior in primary care have been proven effective. However, randomized trials comparing these methods are lacking.
Objective: To compare the effect of two versions of BloodLink, a computer-based clinical decision support system, on blood test ordering among general practitioners.
Design: Randomized trial.
Setting: 44 practices of general practitioners in the region of Delft, the Netherlands.
Participants: 60 general practitioners in 44 practices who used computer-based patient records in their practices.
Intervention: After stratification by solo practices and group practices, practices were randomly assigned to use BloodLink-Restricted, which initially displays a reduced list of tests, or BloodLink-Guideline, which is based on the guidelines of the Dutch College of General Practitioners.
Measurements: Average number of blood tests ordered per order form per practice.
Results: General practitioners who used BloodLink-Guideline requested 20% fewer tests on average than did practitioners who used BloodLink-Restricted (mean [±SD], 5.5 ± 0.9 tests vs. 6.9 ± 1.6 tests, respectively; P = 0.003, Mann–Whitney test).
Conclusions: Decision support based on guidelines is more effective in changing blood test–ordering behavior than is decision support based on initially displaying a limited number of tests. Guideline-driven decision support systems can be effective in reducing the number of laboratory tests ordered by primary care practitioners.
- Decision support systems, clinical
- Physician practice patterns
- Hematologic tests
- Practice guidelines
- Primary health care
Article and Author Information
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Acknowledgments:The authors thank the general practitioners who participated in the study: J.M. Baks, R.D.W. van Bentveld, Y.J. Bezuijen, J.P. Bijl, P. de Blooy, C.M.J. Bonekamp, G.O. Boonstra, H. Breedveldt Boer, J. Breugem, J.A. Brienen, P.J.A. Bucx, H.B.F. Derksen, W. van Donselaar, E. Driever, R.H. Dupuis, P. van der Endt, J.A.J. Garretsen, R. Glotzbach, R.J. de Haan, H. Harmans, M. Human-Breedveld, C. Jansen, C.H.F. Jonker, M. Jonquiere, P.E. Kalsbeek, W. Kamermans, L.E.M. Kleipool, A.M.A. van der Knaap, S.J. Kool, M.I.Th. Koopmans, P.C.J.M. Kop, E.H.M. Lange, S. Laverman, S.J. Lindenhout, M. Luitse, D. Maring, S. van der Meer, P.J.Th.M. Meijs, J.E.G. Nieuwkamer, J.B.M. Nijkamp, J. Oosthoek, M.A. Plasmans, L. Redel, A.R.N. van Rijckevorsel, F.J.N. Rijkee, W.F. Sandhövel, P.P.M. Schijen, F. Schreuder, H.S. Spijker, M. Steentjes, R. van Stijn, E.P.L.A. Timmermans, F.C.M. Touw, P.S.W. Verheyden, P.D. Visser, H.W. Visser, H.J.P. Vos, C. van der Weg, W. Wierema.
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Grant Support:By Ziektekostenverzekering Delft Schieland Westland, Institüt Ziektekostenverzekering Ambtenaren, and the European Commission Fourth Framework Health Telematics Programme (project PROMPT [Protocols for Medical Procedures and Therapies]).
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Requests for Single Reprints:Marc A.M. van Wijk, MD, PhD, Institute of Medical Informatics, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands; e-mail, wijk{at}mi.fgg.eur.nl.
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Current Author Addresses:Drs. van Wijk, van der Lei, and van Bemmel and Mr. Mosseveld: Department of Medical Informatics, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands.
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Dr. Bohnen: Department of Primary Care Medicine, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands.
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Author Contributions:Conception and design: M.A.M. van Wijk, A.M. Bohnen, J.H. van Bemmel.
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Analysis and interpretation of the data: M.A.M. van Wijk, J. van der Lei, A.M. Bohnen.
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Drafting of the article: M.A.M. van Wijk, J. van der Lei.
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Critical revision of the article for important intellectual content: M.A.M. van Wijk, J. van der Lei, A.M. Bohnen.
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Final approval of the article: J. van der Lei, A.M. Bohnen.
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Statistical expertise: J. van der Lei.
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Administrative, technical, or logistic support: M. Mosseveld.
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Collection and assembly of data: M.A.M. van Wijk, M. Mosseveld.
- Copyright ©2004 by the American College of Physicians
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