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Clinical Chemistry 49: 1997-2005, 2003. First published November 13, 2003; 10.1373/clinchem.2003.021220
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Right arrow Evidence Based Laboratory Medicine and Test Utilization
(Clinical Chemistry. 2003;49:1997-2005.)
© 2003 American Association for Clinical Chemistry, Inc.

Evidence-based Medicine and Test Utilization

Population-based Study of Repeat Laboratory Testing

Carl van Walraven1,a and Michael Raymond2 for the Network of Eastern Ontario Medical Laboratories (NEO-MeL)

1 Clinical Epidemiology Program, Ottawa Health Research Institute, C405, Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9, Canada.
2 Department of Pathology, Queen’s University, Kingston, Ontario, Canada.

aAuthor for correspondence. Fax 613-761-5492; e-mail carlv{at}ohri.ca.

Background: Test repetition could be a readily modifiable component of laboratory utilization. Laboratory test repetition has not been rigorously studied at a population-based level. Our objective was to determine the prevalence of, and charges associated with, repetition of eight common laboratory tests.

Methods: We performed a cross-sectional study using high-quality, population-based clinical databases that included adults in Eastern Ontario, Canada, between September 1999 and September 2000 for incidence of repeating eight common laboratory tests (hemoglobin, sodium, creatinine, thyrotropin, total cholesterol, HDL-cholesterol, ferritin, and hemoglobin A1C). Tests were classified as potentially redundant if repeated within the test’s baseline testing interval. For creatinine, sodium, and hemoglobin, only tests repeated in the community were considered. For a sensitivity analysis, we varied the repeat interval by 25%, excluded tests repeated by different physicians, and excluded repeats of normal tests.

Results: Almost 4 million tests were conducted during the study year. Most tests (76%) were conducted on patients in the community. More than one-half of all people in the population had at least one laboratory test, with an overall testing rate of 367 tests per 100 people per year. Repeat testing within 1 month accounted for 30% of all utilization (109 repeat tests per 100 people per year). Repetition was more common in hospitalized patients, varied extensively among tests, and was concentrated in a limited number of people. For the eight tests included in the study, charges of potentially redundant repetition in adults totaled between $13.9 and $35.9 million (Canadian) annually.

Conclusions: Laboratory test repetition is very common, makes up a significant component of overall test utilization, and is costly.




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