How do experts determine where to intervene on test ordering? An interview study

Eyal Podolsky; Natasha Hudek; Nicola McCleary; Christopher McCudden; Justin Presseau; Jamie C. Brehaut

doi:10.1515/cclm-2024-0948

Article

How do experts determine where to intervene on test ordering? An interview study

Eyal Podolsky , Natasha Hudek , Nicola McCleary , Christopher McCudden , Justin Presseau and Jamie C. Brehaut

Published/Copyright: September 23, 2024

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 3

Abstract

Objectives

Lab testing is a high-volume activity that is often overused, leading to wasted resources and inappropriate care. Improving test ordering practices in tertiary care involves deciding where to focus scarce intervention resources, but clear guidance on how to optimize these resources is lacking. We aimed to explore context-sensitive factors and processes that inform individual decisions about laboratory stewardship interventions by speaking to key interest holders in this area.

Methods

We conducted semi-structured interviews with test-ordering intervention development experts and authors of test-ordering guidance documents to explore five broad topics: 1) processes used to prioritize tests for intervention; 2) factors considered when deciding which tests to target; 3) measurement of these factors; 4) interventions selected; 5) suggestions for a framework to support these decisions. Transcripts were double coded using directed-content and thematic analysis.

Results

We interviewed 14 intervention development experts. Experts noted they frequently consider test volume, test value, and patient care when deciding on a test to target. Experts indicated that quantifying many relevant factors was challenging. Processes to support these decisions often involved examining local data, obtaining buy-in, and relying on an existing guideline. Suggestions for building a framework emphasized the importance of collaboration, consideration of context and resources, and starting with “easy wins” to gain support and experience.

Conclusions

Our study provides insight into the factors and processes experts consider when deciding which tests to target for intervention and can inform the development of a framework to guide the selection of tests for intervention and guideline development.

Keywords: laboratory testing; low-value care; semi-structured interview

Corresponding author: Jamie C. Brehaut, PhD, Senior Scientist, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Methodological and Implementation Research (MIR) Program, The Ottawa Hospital, General Campus, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada; and School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada, E-mail: jbrehaut@ohri.ca

Funding source: Canadian Institutes of Health Research

Award Identifier / Grant number: #PJT 156031

Research ethics: The study was approved by the Ottawa Health Science Network Research Ethics (OHSN-REB# 20180626-01H).
Informed consent: Informed consent was obtained from all individuals included in this study.
Author contributions: JCB, CM, and JP were responsible for the conception of this project and provided guidance and expertise throughout the entire project. EP, NH, and NMc conducted the interviews and data analysis. EP drafted the manuscript, and JCB, NH, CM, JP, and NMc provided critical input and revision of the manuscript. All authors reviewed and approved the final manuscript.
Use of Large Language Models, AI and Machine Learning Tools: None declared.
Conflict of interest: The authors state no conflict of interest.
Research funding: This work was supported by the Canadian Institutes of Health Research (CIHR) grant #PJT 156031. Funding bodies had no role in the design of the study, collection, analysis, interpretation of data, or in the writing of the manuscript.
Data availability: The authors may be contacted for data and material requests. However, the data pertaining to individual participants will not be shared to protect participant privacy.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2024-0948).

Received: 2024-06-13

Accepted: 2024-09-05

Published Online: 2024-09-23

Published in Print: 2025-02-25

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Supplementary Material

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Keywords for this article

laboratory testing; low-value care; semi-structured interview