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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2020

01-12-2020 | Folic Acid | Research article

Preventing overuse of laboratory diagnostics: a case study into diagnosing anaemia in Dutch general practice

Authors: Michelle M. A. Kip, Martijn L. J. Oonk, Mark-David Levin, Annemarie Schop, Patrick J. E. Bindels, Ron Kusters, Hendrik Koffijberg

Published in: BMC Medical Informatics and Decision Making | Issue 1/2020

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Abstract

Background

More information is often thought to improve medical decision-making, which may lead to test overuse. This study assesses which out of 15 laboratory tests contribute to diagnosing the underlying cause of anaemia by general practitioners (GPs) and determines a potentially more efficient subset of tests for setting the correct diagnosis.

Methods

Logistic regression was performed to determine the impact of individual tests on the (correct) diagnosis. The statistically optimal test subset for diagnosing a (correct) underlying cause of anaemia by GPs was determined using data from a previous survey including cases of real-world anaemia patients.

Results

Only 9 (60%) of the laboratory tests, and patient age, contributed significantly to the GPs’ ability to diagnose an underlying cause of anaemia (CRP, ESR, ferritin, folic acid, haemoglobin, leukocytes, eGFR/MDRD, reticulocytes and serum iron). Diagnosing the correct underlying cause may require just five (33%) tests (CRP, ferritin, folic acid, MCV and transferrin), and patient age.

Conclusions

In diagnosing the underlying cause of anaemia a subset of five tests has most added value. The real-world impact of using only this subset should be further investigated. As illustrated in this case study, a statistical approach to assessing the added value of tests may reduce test overuse.
Appendix
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Metadata
Title
Preventing overuse of laboratory diagnostics: a case study into diagnosing anaemia in Dutch general practice
Authors
Michelle M. A. Kip
Martijn L. J. Oonk
Mark-David Levin
Annemarie Schop
Patrick J. E. Bindels
Ron Kusters
Hendrik Koffijberg
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Folic Acid
Published in
BMC Medical Informatics and Decision Making / Issue 1/2020
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-020-01198-8

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