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

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

Research output: Contribution to journalArticleAcademicpeer-review

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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.

Original languageEnglish
Article number178
Number of pages1
JournalBMC medical informatics and decision making
Issue number1
Publication statusPublished - 31 Jul 2020


  • Anemia
  • Data analysis, statistical
  • Diagnoses and laboratory examinations
  • General practice
  • Optimal testing
  • Overuse


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