The Impact of a Standardized Pre-visit Laboratory Testing Panel in the Internal Medicine Outpatient Clinic: a Controlled "On-Off" Trial
Vrijsen, B E L; Ten Berg, M J; Naaktgeboren, C A; Vis, J Y; Dijstelbloem, H M; Westerink, J; Dekker, D; Hoefer, I E; Haitjema, S; Hulsbergen-Veelken, C A R; van Solinge, W W; Kaasjager, H A H
(2021) Journal of General Internal Medicine, volume 36, issue 7, pp. 1914 - 1920
(Article)
Abstract
Background: In several settings, a shorter time to diagnosis has been shown to lead to improved clinical outcomes. The implementation of a rapid laboratory testing allows for a pre-visit testing in the outpatient clinic, meaning that test results are available during the first outpatient visit. Objective: To determine whether the
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pre-visit laboratory testing leads to a shorter time to diagnosis in the general internal medicine outpatient clinic. Design: An “on-off” trial, allocating subjects to one of two treatment arms in consecutive alternating blocks. Participants: All new referrals to the internal medicine outpatient clinic of a university hospital were included, excluding second opinions. A total of 595 patients were eligible; one person declined to participate, leaving data from 594 patients for analysis. Intervention: In the intervention group, patients had a standardized pre-visit laboratory testing before the first visit. Main Measures: The primary outcome was the time to diagnosis. Secondary outcomes were the correctness of the preliminary diagnosis on the first day, health care utilization, and patient and physician satisfaction. Key Results: There was no difference in time to diagnosis between the two groups (median 35 days vs 35 days; hazard ratio 1.03 [0.87–1.22]; p =.71). The pre-visit testing group had higher proportions of both correct preliminary diagnoses on day 1 (24% vs 14%; p =.003) and diagnostic workups being completed on day 1 (10% vs 3%; p <.001). The intervention group had more laboratory tests done (50.0 [interquartile range (IQR) 39.0–69.0] vs 43.0 [IQR 31.0–68.5]; p <.001). Otherwise, there were no differences between the groups. Conclusions: Pre-visit testing did not lead to a shorter overall time to diagnosis. However, a greater proportion of patients had a correct diagnosis on the first day. Further studies should focus on customizing pre-visit laboratory panels, to improve their efficacy. Trial Registration: NL5009
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Keywords: ambulatory care, clinical chemistry tests, diagnosis, Internal Medicine, Journal Article
ISSN: 0884-8734
Publisher: Springer New York
Note: Funding Information: The authors would like to thank all the patients who participated in the study, the physicians working in the general internal medicine outpatient clinic, and everyone who contributed to this study. In particular, the authors thank Roos Boerman, Saskia Briedé, Linda Everlo, Shanna de Groot, Willemijn Huiszoon, Rebecca Knobbe, Mathilde Nijkeuter, Matthijs van Oevelen, Marieke de Regt, Annemieke Tinholt, Dirk Tjwa, Jan Willem Uffen, Maaike Weijmans, Maria de Winter, and Tom Wouters for participating in the expert panel; Joris de Groot and Hans Reitsma for their advice on study design; Ad van Mullem, Ronald Swinkels, Marjon Wesseling, and Jantien Woudstra-de Liefde for their help with the logistics of the study; and Marianne Schurink, Bianca Silvius, and Maartje Woelders for their help with data collection. Publisher Copyright: © 2021, The Author(s).
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