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Clinical Chemistry 52: 2219-2228, 2006. First published October 19, 2006; 10.1373/clinchem.2006.072934
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Right arrow Evidence Based Laboratory Medicine and Test Utilization
(Clinical Chemistry. 2006;52:2219-2228.)
© 2006 American Association for Clinical Chemistry, Inc.

Evidence-Based Laboratory Medicine and Test Utilization

Effect of Provider Continuity on Test Repetition

Carl van Walravena, Geta Cernat and Peter C. Austin

1 Network of Eastern Ontario Medical Laboratories (NEO-MeL), Ottawa, ONT Canada.

aAddress correspondence to this author at: Clinical Epidemiology Program, Ottawa Health Research Institute, C405, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa ONT, K1Y 4E9 Canada. Fax 613-761-5492; e-mail carlv{at}ohri.ca.

Background: Provider continuity (PC) occurs when a patient is treated by the same physician over time. A perceived benefit of PC is decreased test repetition. Repeat tests make up a significant proportion of overall laboratory utilization. This study determined whether test repetition increases when PC decreases.

Methods: Cohort study of adults in eastern Ontario, Canada between September 1999 and September 2000 using population-based clinical databases. The primary study outcome was the probability that 7 common laboratory tests (hemoglobin, sodium, creatinine, thyrotropin, total cholesterol, ferritin, and hemoglobin A1C) were repeated at physician visits subsequent to the index test. We determined whether the probability of test repetition changed if the follow-up physician ordered the index test. We adjusted for multiple factors regarding the patient (age, sex, days in hospital, and number of physician visits in previous year), index test (normality and location), follow-up visit (location and time from index test), and follow-up physician (age and specialty).

Results: The study included 881 353 patients, 1 419 438 index laboratory tests, and 7 622 938 follow-up physician visits. After adjusting for other important factors, we found that tests were significantly more likely to be repeated if the follow-up physician ordered the index test (adjusted odds ratio range 2.5–5.9). This association was consistent in most subgroups.

Conclusions: For these common laboratory investigations, PC was associated with increased, not decreased, test repetition. This suggests that increased PC alone will likely not decrease test utilization.






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Copyright © 2006 by the American Association for Clinical Chemistry.