TEST UTILIZATION PRACTICES IN HAMAD MEDICAL CORPORATION: LABORATORIES AND CLINICIANS

Abstract

Background Improper test utilization is a common problem of all healthcare systems. It costs vast amount of money without improving the patient care. There are three types of this inappropriate utilization of laboratory test including overused, underused and misused. One can result in another. In developed countries, like the USA, are trying to minimize such problem with many tools and technologies. The goals of this project are to (i) Identify laboratories’ tests that are improperly utilized, (ii) investigate the laboratories’ actions toward such test utilization practices, (iii) identify reasons affect physicians’ decisions in ordering lab tests, and (iv) establish a future background for more specific investigations of test. Materials and methods: Two different types of online surveys, each was 10-15 minutes, had been distributed to laboratory supervisors and physicians at Hamad Medical Corporation (HMC). More information was acquired through three different personal interviews; one with the director of the laboratory service and two with laboratory supervisors. Results: Fourteen laboratory supervisors and eighty-eight physicians had been surveyed. This study showed that the supervisors were not getting the right supportive educational courses about best practice to manage the laboratory of laboratory test utilization management. Moreover, the communications between the physicians and the laboratories were very weak and not systemized. In addition, 14 types of improperly utilized tests had been identified. Numerous factors are affecting physicians ordering pattern. When ordering a test, 59% physicians were not alerted about the redundant tests. While 78.4% participated physicians were using the clinical guidelines, surprisingly, 73% were not using the laboratory handbook, and 9.1% stated it is not useful. All physicians were asking their colleagues about the right laboratory tests to be ordered. Whereas 84% of physicians prefer to get feedback about an appropriate practice, 51% were not receiving any feedback, and 40.1% got them rarely. Many physicians (67%) were not aware of the cost of testing, and many of them (63%) showed their readiness to reduce their test orders if they were expensive. Conclusion: This is the first study about lab test utilization conducted at HMC and is providing a future background for further specific investigations. Most of the laboratory supervisors did not receive any training about best practice of laboratory utilization. Improper utilization of laboratory tests like HbA1c, vitamin D, and genetic testing had been showed by our study and evidenced by others. In order to request the appropriate test for their patients, physicians should be given regular feedback and encouraged to use laboratory handbook. At the time of ordering lab tests, alerts including previous test results and cost were preferred by many physicians and could affect their decisions. Pathologists interpretations should be reviewed and written in a way that provides most effective guidance to the physicians to order the right test or laboratory service. This study showed a great need for a culture change to be established by senior physicians and supervisors to ensure appropriate test utilization. Countless factors are causing inappropriate test utilization practices, yet many to be discovered with in-depth inquiries of each laboratory with the goal to reduce costs and improve overall processes.