Evidence-based Laboratory Test Order Sets in Primary Care

Conditions

Acute Coronary Syndrome, Anemia, Cardiovascular Diseases, Chronic Kidney Diseases, Diabetes Mellitus, Diarrhea, Fatigue, General Check-up, Gout, Hypertension, Liver Diseases, Lung Embolism, Medication Monitoring, Obesity, Rheumatoid Arthritis, Sexually Transmitted Diseases, Thyroid Diseases

Keywords

order sets, decision support, laboratory test, primary care

Brief summary

Cluster randomised controlled trial to evaluate what the effect is of evidence-based order sets aimed at five indications on the appropriateness of laboratory test ordering in primary care.

Detailed description

Cluster randomised controlled trial in Belgian primary care practices. Participants will be primary care physicians working in primary care practices affiliated to one of three collaborating laboratories in the Leuven, Ghent or Antwerp regions. Primary care practices will be allocated and randomized to either the intervention or control group. Physicians in PCPs randomized to the intervention will be offered order sets based on indication when using the CPOE for ordering laboratory tests. The effect of order sets will be analyzed for 17 common indications for ordering laboratory tests in Belgian primary care: diabetes mellitus, hypertension, cardiovascular disease, general check-up, unexplained fatigue, anemia, liver pathology, medication monitoring, gout, chronic kidney disease, lung embolism, acute coronary syndrome, diarrhea, thyroid disease, sexually transmitted disease, rheumatoid arthritis and obesity.

Veerle Piessens, Nicolas Delvaux, Stefan Heytens, Bert Aertgeerts, An De Sutter

BMJ Open2022-04-013 citations

10.1136/bmjopen-2021-059261

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial.

Delvaux N, Piessens V, Burghgraeve T, Mamouris P, Vaes B, Stichele RV, Cloetens H, Thomas J, Ramaekers D, Sutter A, Aertgeerts B.

2020-11-0418 citations

10.1186/s13012-020-01059-y

Electronic Laboratory Medicine ordering with evidence-based Order sets in primary care (ELMO study): protocol for a cluster randomised trial.

Delvaux N, De Sutter A, Van de Velde S, Ramaekers D, Fieuws S, Aertgeerts B.

2017-12-068 citations

10.1186/s13012-017-0685-6

Interventions

OTHERCPOE with order sets for lab testing

CPOE including series of recommended tests ordered per indication

OTHERCPOE without order sets for lab testing

CPOE only

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

DIAGNOSTIC

Masking

SINGLE (Investigator)

Eligibility

Sex/Gender

ALL

Healthy volunteers

Yes

Inclusion criteria

* Primary care practices will be considered eligible if all the physicians active in the practice agree to be involved in the study * All family physicians will be considered eligible if they: * Collaborate with either MCH, Anacura or AML for their laboratory test orders * Agree to use the online CPOE for their laboratory test orders * Use a computerized EHR for patient care * Agree to the terms in the informed consent

Exclusion criteria

* Primary care practices where one or more physicians refuse to be enrolled will be excluded

Design outcomes

Primary

Measure	Time frame	Description
Appropriateness	3 months	number of appropriate tests for 17 study indications

Secondary

Measure	Time frame	Description
Missed or delayed diagnoses	1 year	Incidence of missed or delayed diagnoses after laboratory test
Laboratory test volume	1 year	Total volume of ordered laboratory tests

Other

Measure	Time frame	Description
Downstream or cascade clinical activities	1 year	All downstream or cascade clinical activities as a result of abnormal test result

Countries

Belgium

Outcome results

None listed