Abstract
INTRODUCTION: In recent years, advancements in imaging and laboratory tests have significantly enhanced diagnostic capabilities in modern healthcare systems. Misuse and overuse of these tools may have serious consequences on both patient care and the efficiency of healthcare systems. This study aimed to evaluate the direct impact of a novel methodology on the utilization patterns of diagnostic tests and on hospital expenditures, as well as its indirect effects on clinical and operational parameters. METHODS: A retrospective descriptive study, which included an economic evaluation, focused on assessing the impact of Rambam health care Campus medical center's SMART Medicine (SM) initiative, launched in 2014. Data from pre-implementation (2012-2013) and post-implementation (2015-2020) periods were compared. Test usage patterns, operational outcomes, and clinical outcomes (In-hospital mortality and 30-day readmission) were analyzed, and an economic assessment was conducted. RESULTS: The implementation of the SM methodology led to a notable reduction of 33% in laboratory test usage. This initiative effectively reduced most tests. The imaging tests remained unchanged. The initiative had a significant positive and sustainable impact on all departments. Economic analysis demonstrated a considerable reduction in the annual number of laboratory tests, resulting in annual savings of $265,000. The average number of tests per hospitalization decreased from 8.5 to 4.7. In addition, operational parameters were improved. Importantly, there were no significant changes in hospital mortality rates or 30-day readmission rates. CONCLUSIONS: The implementation of the SM methodology led to a substantial decrease in diagnostic test usage and related costs within internal medicine departments, while improving in operational efficiency, without affecting clinical outcomes. This study illustrates that the process of how physicians conduct medical diagnostics can be redesigned. KEY MESSAGES: • Diagnostic tests can be efficiently reduced without harming clinical outcomes. • Redesigning the way in which physicians conduct medical diagnostics may improve the efficiency of health care systems.