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 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 pr... Mehr ...

Verfasser: Kip, M.M.A. (Michelle M A)
Oonk, M.L.J. (Martijn L J)
Levin, M.-D. (Mark-David)
Schop, A. (Annemarie)
Bindels, P.J.E. (Patrick)
Kusters, R. (Ron)
Koffijberg, H. (Hendrik)
Dokumenttyp: Artikel
Erscheinungsdatum: 2020
Schlagwörter: Anemia / Data analysis / statistical / Diagnoses and laboratory examinations / General practice / Optimal testing / Overuse
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-26677348
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : http://repub.eur.nl/pub/129478

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.