TY - JOUR
T1 - Cascade effects of laboratory testing are found to be rare in low disease probability situations: prospective cohort study
AU - Houben, Paul H. H.
AU - van der Weijden, Trudy
AU - Winkens, Ron A. G.
AU - Grol, Richard P. T. M.
PY - 2010/4
Y1 - 2010/4
N2 - Objectives: (1) To investigate the frequency of cascades of further diagnostic investigations and referrals after abnormal laboratory results in situations of low disease probability; (2) to investigate pretest and posttest determinants; and (3) to describe the cascades that occur. Study Design and Setting: Prospective cohort study in primary care in The Netherlands. Numbers of investigations/referrals were recorded during 6 months of follow-up for 256 patients with normal and abnormal laboratory results. The influences of the reason for ordering tests, interpretation of results, and pretest/posttest disease probability were examined. Results: After receiving the laboratory results, the physicians ordered further investigations for 22 (17.3%) patients with abnormal results and for two (1.6%) patients with normal results (P < 0.001). They referred 12 (9.4%) patients with abnormal results and eight (6.2%) patients with normal results (P = 0.33). Six patients had two investigations and/or referrals, and one patient had three referrals. There were significantly more investigations/referrals for results interpreted as abnormal (P = 0.004) and for cases with a high posttest disease probability (P = 0.001). Conclusion: This study suggests that cascade processes after laboratory testing in situations of low disease probability are limited in magnitude and frequency. Improving interpretations may help improve the appropriateness of further investigations and referrals.
AB - Objectives: (1) To investigate the frequency of cascades of further diagnostic investigations and referrals after abnormal laboratory results in situations of low disease probability; (2) to investigate pretest and posttest determinants; and (3) to describe the cascades that occur. Study Design and Setting: Prospective cohort study in primary care in The Netherlands. Numbers of investigations/referrals were recorded during 6 months of follow-up for 256 patients with normal and abnormal laboratory results. The influences of the reason for ordering tests, interpretation of results, and pretest/posttest disease probability were examined. Results: After receiving the laboratory results, the physicians ordered further investigations for 22 (17.3%) patients with abnormal results and for two (1.6%) patients with normal results (P < 0.001). They referred 12 (9.4%) patients with abnormal results and eight (6.2%) patients with normal results (P = 0.33). Six patients had two investigations and/or referrals, and one patient had three referrals. There were significantly more investigations/referrals for results interpreted as abnormal (P = 0.004) and for cases with a high posttest disease probability (P = 0.001). Conclusion: This study suggests that cascade processes after laboratory testing in situations of low disease probability are limited in magnitude and frequency. Improving interpretations may help improve the appropriateness of further investigations and referrals.
KW - Primary health care
KW - Clinical chemistry tests
KW - Diagnostic tests, routine
KW - Quality assurance, health care
KW - Decision making
KW - Professional practice
U2 - 10.1016/j.jclinepi.2009.08.004
DO - 10.1016/j.jclinepi.2009.08.004
M3 - Article
C2 - 19880283
SN - 0895-4356
VL - 63
SP - 452
EP - 458
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 4
ER -