To investigate the cost-benefit and durability of feedback strategy to physicians for reducing unnecessary laboratory tests and expenditure. A prospective quasi-experimental trial with concurrent comparison group and historical comparison. A medical center in Taiwan. A total of 225,675 patient-visits for 13family physicians and 1,464,748 patient-visits for the 43 enrolled internists, conducted from January 1998 to December 2000. Family physicians received monthly feedback in year 1999 on their use of laboratory tests of the preceding month. Internists(comparison group) received no intervention. Mean number of tests and laboratory expenditure per prescription from 1998to 2000. When compared with prescriptions in year 1998, mean number of tests per prescription in 1999 decreased in both groups(p<0.01) with a more marked decrease in the intervention group(p<0.0001), and mean laboratory expenditure per prescription in 1999 decreased in the feedback group(p<0.01), but increased in the comparison group(p<0.01). When compared with prescriptions in year 1999, mean number of tests and laboratory expenditure per prescription in 2000 decreased in both groups(p<0.01) with a more marked decrease in the intervention group(p<0.0001). The cost of feedback was US$1,588.6. Total saving from reduced tests was US$184,669.5. Periodic peer comparison feedback to physicians on their test-ordering behavior to reduce laboratory expenditure is cost-effective, The effectiveness can persist for at least 1 year after the end of feedback intervention.
To investigate the cost-benefit and durability of feedback strategy to physicians for reducing unnecessary laboratory tests and expenditure. A prospective quasi-experimental trial with concurrent comparison group and historical comparison. A medical center in Taiwan. A total of 225,675 patient-visits for 13family physicians and 1,464,748 patient-visits for the 43 enrolled internists, conducted from January 1998 to December 2000. Family physicians received monthly feedback in year 1999 on their use of laboratory tests of the preceding month. Internists(comparison group) received no intervention. Mean number of tests and laboratory expenditure per prescription from 1998to 2000. When compared with prescriptions in year 1998, mean number of tests per prescription in 1999 decreased in both groups(p<0.01) with a more marked decrease in the intervention group(p<0.0001), and mean laboratory expenditure per prescription in 1999 decreased in the feedback group(p<0.01), but increased in the comparison group(p<0.01). When compared with prescriptions in year 1999, mean number of tests and laboratory expenditure per prescription in 2000 decreased in both groups(p<0.01) with a more marked decrease in the intervention group(p<0.0001). The cost of feedback was US$1,588.6. Total saving from reduced tests was US$184,669.5. Periodic peer comparison feedback to physicians on their test-ordering behavior to reduce laboratory expenditure is cost-effective, The effectiveness can persist for at least 1 year after the end of feedback intervention.