The Impact of a Standardized Pre-visit Laboratory Testing Panel in the Internal Medicine Outpatient Clinic: a Controlled "On-Off" Trial.

Autor: Vrijsen BEL; Department of Internal Medicine, Division Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, F02.216, PO Box 85500, 3508 GA, Utrecht, the Netherlands. b.e.l.vrijsen@umcutrecht.nl., Ten Berg MJ; Central Diagnostic Laboratory, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Naaktgeboren CA; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Vis JY; Central Diagnostic Laboratory, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.; Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands., Dijstelbloem HM; Central Diagnostic Laboratory, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Westerink J; Department of Internal Medicine, Division Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, F02.216, PO Box 85500, 3508 GA, Utrecht, the Netherlands., Dekker D; Department of Internal Medicine, Division Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, F02.216, PO Box 85500, 3508 GA, Utrecht, the Netherlands., Hoefer IE; Central Diagnostic Laboratory, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Haitjema S; Central Diagnostic Laboratory, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Hulsbergen-Veelken CAR; Central Diagnostic Laboratory, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., van Solinge WW; Central Diagnostic Laboratory, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Kaasjager HAH; Department of Internal Medicine, Division Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, F02.216, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2021 Jul; Vol. 36 (7), pp. 1914-1920. Date of Electronic Publication: 2021 Jan 22.
DOI: 10.1007/s11606-020-06453-2
Abstrakt: 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 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.
(© 2021. The Author(s).)
Databáze: MEDLINE
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