PMID: 2115577Jul 1, 1990Paper

Practice guidelines to reduce testing in the hospital

Journal of General Internal Medicine
T Wachtel, P O'Sullivan

Abstract

To reduce testing among hospitalized patients using practice guidelines for any of 14 medical problems. Comparison of test use before and after implementation of guidelines. The guidelines were developed by consensus panels of self-selected participating physicians. Non-participating physicians were monitored during the same periods. In addition, the two groups of physicians were evaluated similarly for their management of three medical problems for which guidelines were not developed. Acute care hospital. 1,638 hospitalized patients and their 79 physicians. Implementation of practice guidelines for the care of hospitalized patients. Geometric mean charges expressed in inflation-adjusted dollars were used as measures of test use. For the intervention group, laboratory tests decreased by 20.6%, x-rays by 42.3%, and EKGs by 34.2%. All the decreases were significant (p = 0.001). The non-participating physicians who were higher test users during both years of the study also achieved significant (p less than 0.05) but smaller reductions during the intervention year: 13.9% for laboratory tests, 30.3% for x-rays, and 21.8% for EKGs, perhaps because the same residents were involved in the care of both groups of patients. For the non-gu...Continue Reading

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