Evidence-based Laboratory Test Order Sets in Primary Care

Study Overview
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Brief Summary
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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
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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.

Official Title
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The Effect of Evidence-based Order Sets Within a CPOE System on the Quantity and Quality of Laboratory Test Ordering in Family Practice: a Cluster Randomised Trial

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

Intervention / Treatment
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* Other: CPOE with order sets for lab testing
* Other: CPOE without order sets for lab testing


Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CPOE with order sets<br>Physicians who use CPOE including order sets for large range of indications. | Other: CPOE with order sets for lab testing<br>* CPOE including series of recommended tests ordered per indication<br>* Other names: CPOE with order sets for laboratory testing;|
| Active Comparator: CPOE without order sets<br>Physicians who use CPOE without order sets. | Other: CPOE without order sets for lab testing<br>* CPOE only<br>* Other names: CPOE without order sets for laboratory testing;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Appropriateness | number of appropriate tests for 17 study indications | 3 months | 

Secondary Outcome Measures

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

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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order sets, decision support, laboratory test, primary care