Does pre-ordering tests enhance the value of the periodic examination? Study Design - Process implementation with retrospective chart review

Background: To evaluate the value of a pre-ordering process for the pro-active scheduling and completion of appropriate preventive and chronic disease monitoring tests prior to a periodic health examination (PHE). Methods. A standardized template was developed and used by our nursing staff to identify and schedule appropriate tests prior to the patients PHE. Chart reviews were completed on all 602 PHE visits for a 3-month interval in a primary care setting. A patient satisfaction survey was administered to a convenience sample of the PHE patients. Results: Of all the patients with tests pre-ordered, 87.8% completed the tests. All providers in the division used the process, but some evolved from one template to another over time. Most patients (61%) preferred to get their tests done prior to their PHE appointment. Many of our patients had abnormal test results. With this process, patients were able to benefit from face-to-face discussion of these results directly with their provider. Conclusions: A pre-order process was successfully implemented to improve the value of the PHE visit in an internal medicine primary care practice using a standardized approach that allowed for provider autonomy. The process was accepted by patients and providers and resulted in improved office efficiency through reduced message handling. Completion of routine tests before the PHE office visit can help facilitate face-to-face discussions about abnormal results and subsequent management that otherwise may only occur by telephone.