PubMed · 10303667
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1989. QA methodologies.. https://pubmed.ncbi.nlm.nih.gov/10303667/
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BACKGROUND: Different methods for changing blood test-ordering behavior in primary care have been proven effective. However, randomized trials comparing these methods are lacking. OBJECTIVE: To compare the effect of two versions of BloodLink, a computer-based clinical decision support system, on blood test ordering among general practitioners. DESIGN: Randomized trial. SETTING: 44 practices of general practitioners in the region of Delft, the Netherlands. PARTICIPANTS: 60 general practitioners in 44 practices who used computer-based patient records in their practices. INTERVENTION: After stratification by solo practices and group practices, practices were randomly assigned to use BloodLink-Restricted, which initially displays a reduced list of tests, or BloodLink-Guideline, which is based on the guidelines of the Dutch College of General Practitioners. MEASUREMENTS: Average number of blood tests ordered per order form per practice. RESULTS: General practitioners who used BloodLink-Guideline requested 20% fewer tests on average than did practitioners who used BloodLink-Restricted (mean [+/-SD], 5.5 +/- 0.9 tests vs. 6.9 +/- 1.6 tests, respectively; P = 0.003, Mann-Whitney test). CONCLUSIONS: Decision support based on guidelines is more effective in changing blood test-ordering behavior than is decision support based on initially displaying a limited number of tests. Guideline-driven decision support systems can be effective in reducing the number of laboratory tests ordered by primary care practitioners.
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In the notification procedure for new substances, the need to conduct further toxicity tests may arise if the outcome of a qualitative or quantitative risk assessment indicates relevant risks. Sometimes a quantitative assessment is not possible (e.g., if a no observed adverse effect level [NOAEL] is not available). A different approach is required for such substances. An approach based on the correlation of the classification of the substance (the possible outcome of testing) with the assumed tolerable exposure levels is presented here. It relates to the hazard band model developed by the Health and Safety Executive (HSE) of the United Kingdom. To aid decision-making, the assumed tolerable exposure level is compared with the estimated workplace exposure level by means of calculating the quotient of these two figures. The quotient is called the assumed margin of safety (AMOS). A quotient higher than 1 means that testing may be deferred. The approach is described for a powdery substance used as a pigment in the coloration of plastics and rubber. Depending on the exposure situation, the need for further testing to determine the repeated dose toxicity of the substance is discussed.