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The Impact of a Standardized Pre-visit Laboratory Testing Panel in the Internal Medicine Outpatient Clinic: a Controlled "On-Off" Trial.
- Source :
-
Journal of general internal medicine [J Gen Intern Med] 2021 Jul; Vol. 36 (7), pp. 1914-1920. Date of Electronic Publication: 2021 Jan 22. - Publication Year :
- 2021
-
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.<br />Objective: To determine whether the pre-visit laboratory testing leads to a shorter time to diagnosis in the general internal medicine outpatient clinic.<br />Design: An "on-off" trial, allocating subjects to one of two treatment arms in consecutive alternating blocks.<br />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.<br />Intervention: In the intervention group, patients had a standardized pre-visit laboratory testing before the first visit.<br />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.<br />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.<br />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.<br />Trial Registration: NL5009.<br /> (© 2021. The Author(s).)
- Subjects :
- Humans
Referral and Consultation
Ambulatory Care Facilities
Subjects
Details
- Language :
- English
- ISSN :
- 1525-1497
- Volume :
- 36
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of general internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 33483828
- Full Text :
- https://doi.org/10.1007/s11606-020-06453-2