Large Differences in Laboratory Utilisation between Hospitals in Sweden

Abstract There are large differences in the use of laboratory tests between hospitals in Sweden. These differences are not only due to differences between the patients treated but also to differences in practice. Use of laboratory test seems to reflect local traditions to a large extent. These large variations in practice are not compatible with the objective of providing care on equal terms and reduce the cost-effectiveness of clinical chemistry. Recently, several intervention studies have been performed in Sweden with the aim to optimise the use of clinical chemistry tests in primary care. The results show that it is possible to reduce the cost in primary care by SEK 100 million per year while increasing the clinical usefulness. This constitutes approximately 10% of the total cost for clinical chemistry tests in primary care. It should also be possible to reduce the cost for clinical chemistry tests in secondary and tertiary care. Hospitals order more tests than primary care and the potential savings are thus greater. We have studied the ordering habits for eleven Swedish hospitals. The comparison was made in the form of ratios between related laboratory tests to reduce the effects of differences in size between the studied laboratories. The large variation between hospitals indicates that a continuous discussion between the clinicians and the laboratories could reduce the cost. We have used the figures from the comparison and calculated the potential savings for seven frequently used tests. The potential yearly saving in Sweden for these tests is approximately SEK 150 million.

[1]  D. Bauer,et al.  Sensitive thyrotropin and free thyroxine testing in outpatients. Are both necessary? , 1996, Archives of Internal Medicine.

[2]  H C Sox,et al.  Modifying test-ordering behavior in the outpatient medical clinic. A controlled trial of two educational interventions. , 1985, Archives of internal medicine.

[3]  R. Plumridge.  Trial of strategy for reducing the use of laboratory tests , 1986 .

[4]  The modern clinical laboratory; Justification, scope, and directions. , 1975, JAMA.

[5]  N. Tryding,et al.  Effects of an education programme to change clinical laboratory testing habits in primary care. , 1999, Scandinavian journal of primary health care.

[6]  J. Zaat,et al.  Laboratory Test Form Design Influences Test Ordering by General Practitioners in the Netherlands , 1992, Medical care.

[7]  M Werner,et al.  A model for medical decision making and problem solving. , 1995, Clinical chemistry.

[8]  M D McNeely,et al.  The influence of an expert system for test ordering and interpretation on laboratory investigations. , 1999, Clinical chemistry.

[9]  J. Knottnerus,et al.  Does a reduction in general practitioners' use of diagnostic tests lead to more hospital referrals? , 1995, The British journal of general practice : the journal of the Royal College of General Practitioners.

[10]  J. Eisenberg,et al.  An educational program to modify laboratory use by house staff. , 1977, Journal of medical education.

[11]  S. Woolf,et al.  Testing for uncommon conditions. The heroic search for positive test results. , 1990, Archives of internal medicine.

[12]  P. Broughton,et al.  Laboratories Respond Differently to the Same Clinical Request , 1989, Annals of clinical biochemistry.

[13]  B. Frier,et al.  Frequency of Thyroid Dysfunction in Diabetic Patients: Value of Annual Screening , 1995, Diabetic medicine : a journal of the British Diabetic Association.

[14]  C. Naylor,et al.  Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. , 1998, JAMA.

[15]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[16]  B Chan,et al.  Effect of population-based interventions on laboratory utilization: a time-series analysis. , 1998, JAMA.

[17]  Lee Goldman,et al.  Cecil Textbook of Medicine , 1985 .

[18]  J T Hindmarsh,et al.  A strategy to promote rational clinical chemistry test utilization. , 1995, American journal of clinical pathology.

[19]  T L Lincoln,et al.  Ready! Fire! . . . Aim! An inquiry into laboratory test ordering. , 1983, JAMA.

[20]  J. Franklyn,et al.  Prevalence and follow‐up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom , 1991, Clinical endocrinology.

[21]  J A Knottnerus,et al.  Effect of feedback on test ordering behaviour of general practitioners. , 1992, BMJ.

[22]  B. Hovelius,et al.  Decentralized laboratory testing: attitudes of physicians and medical students. , 1990, Scandinavian journal of primary health care.