Lab Test Utilization at Teaching versus Nonteaching Hospitals
Researchers in Texas used a statewide all-payer database to compare laboratory test utilization in 11 major teaching hospitals, 12 minor teaching hospitals and 73 nonteaching hospitals for 43,329 patients hospitalized with bacterial pneumonia or cellulitis. These diseases were chosen because cases frequently occur at both types of hospitals and specialized testing is usually not required. The primary outcome measure was mean laboratory orders per hospital day stratified by illness severity, defined as the sum of the individual units billed for laboratory revenue codes divided by LOS. Mean number of laboratory tests per day was highest for major teaching hospitals for both conditions.
Major teaching hospitals averaged 13.2 tests per day for bacterial pneumonia compared to 8.9 tests per day for nonteaching hospitals. For cellulitis: major teaching hospitals averaged 10.4 tests per day and nonteaching hospitals 7.3 tests per day. This association held for all levels of illness severity for both conditions, except for patients with cellulitis and the highest illness severity level.
Although the differences of 3.6 additional laboratory tests per day for pneumonia and 2.6 additional laboratory tests per day for cellulitis did not seem like a lot, the authors clearly illustrated the impact with an interesting vignette. A 42-year-old African American man with Medicaid insurance coverage who was admitted for a 4-night hospital stay with community-acquired pneumonia. If he were admitted to a nonteaching hospital, he would have 9 laboratory tests per day, for a total of 36 laboratory tests, whereas if he were admitted to a major teaching hospital, he would have 13 tests per day, for a total of 52 laboratory tests. This is a 40.0% increase in use of laboratory testing.
This study confirmed the widely held assumption that resident physicians at academic medical centers routinely order more laboratory tests for inpatients compared with more experienced physicians. The authors concluded that future studies should explore potential cultural differences between teaching and nonteaching hospitals and how these differences contribute to increased laboratory testing for conditions that do not routinely require laboratory testing.
Reference
Valencia V. et al. A comparison of laboratory testing in teaching vs nonteaching hospitals for 2 common medical conditions. JAMA Intern Med. doi:10.1001/jamainternmed.2017.6032 Published online November 13, 2017.
