Informatics in Medicine Unlocked (Jan 2021)
Effectiveness of an automated feedback with dashboard on use of laboratory tests by neurology residents
Abstract
Given the lack of empirical evidence and limited literature on dashboard development and its usefulness, it is still not clear how to deliver automated feedback using a dashboard to improve the physicians' practice. Therefore, the present prospective and quasi-experimental study aimed to investigate the effect of automated feedback with a dashboard on ordering laboratory tests by neurology residents. The dashboard development and implementation were performed by an interdisciplinary subcommittee formed in a general teaching hospital with 510 beds in Kashan, Iran. The changes in the laboratory tests ordered by the neurology residents for each patient was considered as the main outcome of the present study, which was assessed three months before the intervention (baseline assessment) and three months during the intervention (post-intervention assessment) to investigate the effectiveness of providing feedback with the dashboard in reducing the number of laboratory tests ordered. Moreover, data analysis was performed using the Kolmogorov–Smirnov test, t-test, and Mann-Whitney test. According to our findings, a total number of 3038 tests were ordered before the intervention, while this value significantly decreased to 1840 in the post-intervention assessment (P = 0.031). In addition, the proportion of laboratory tests per patient was 0.45 ± 0.35 in the baseline assessments, which significantly decreased to 0.37 ± 0.27 after the intervention (P = 0.013), and the monthly number of tests ordered for each patient was 13.14 ± 8.84 pre-intervention, which significantly decreased to 11.09 ± 5.75 after the intervention (P = 0.015). Also, 22 tests out of 29 tests studied were ordered less frequently after the intervention; however, the reduction was significant only for four tests, including the alkaline phosphatase (p = 0.025), high-density lipoprotein (p = 0.037), urine culture (p = 0.037), and arterial blood gas (p = 0.034). We concluded that peer-compared automated feedback with a dashboard could simply change the physicians' behavior in ordering laboratory tests. Given the observed effectiveness in changing the residents' behavior, automated feedback with a dashboard can be integrated into the routine clinical performance evaluations of the medical residents. Nevertheless, more empirical evidence is required to confirm the effectiveness of this intervention before widespread use.
