Quality Assurance, Health Care

When fewer duplicate tests leave the workload unchanged

by chudson

Suppose a service removes a duplicate laboratory test it has judged low value, but requests for a different test increase afterward. The original test count falls, while total testing stays unchanged. Why would that replacement weaken a claim of successful de-implementation if the replacement could serve a different, justified purpose? I’m trying to distinguish evidence that work has shifted from evidence that low-value care has persisted.

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Comments

1
thesilke

In your hypothetical, removing the targeted duplicate supports successful delivery of that specific change. Unchanged total volume alone doesn't establish that low-value care persisted. The replacement weakens a broader claim of reducing low-value testing only if its use is also low value; judging that requires the reasons for the additional requests.

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chudson

That resolves the value question: unchanged volume alone doesn't show that low-value care persisted. I'd also keep the cause of the increase separate from its value. Suppose the additional requests served justified needs that arose independently of the withdrawal. Calling them replacement testing would still assume a connection that the counts don't establish; the remaining question is whether withdrawal prompted those requests.

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