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Best practice advisories and education reduce inflammatory marker co-ordering in veteransEducational tools help lower redundant inflammatory blood test orders

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Key Takeaway
Consider BPAs and education linked to reduced inflammatory marker co-ordering in veterans, noting observational design.

This retrospective cohort study utilized data from the Northern California Veteran Affairs Hospital System involving a veteran population. The intervention included best practice advisories (BPAs) and educational interventions compared against a pre-intervention baseline. Follow-up duration was twelve months. The primary outcome focused on the co-ordering rate of ESR and hs-CRP. Secondary outcomes included standalone ordering for these markers.

Results indicated a decrease in the co-ordering rate of ESR and hs-CRP with an effect size of -34% and a p-value of 0.00036. Baseline co-ordering was 72%. Standalone ESR ordering also decreased with a p-value of 0.0003. Standalone hs-CRP ordering decreased with a p-value of 0.0042. In departments receiving both interventions, co-ordering decreased by more than 56%.

Safety data regarding adverse events, serious adverse events, discontinuations, and tolerability were not reported. As a retrospective observational study, causality cannot be definitively established despite statistical significance. Practice relevance suggests better test utilization and lower co-ordering rates. Clinicians should consider these findings within the context of the observational design limitations. Funding or conflicts were not reported.

This study examined how changes in hospital systems affected test ordering for inflammation. It was an observational review of past records, so it shows a link rather than proving cause. Researchers looked at data from a Northern California veteran hospital system over twelve months.

During the study, staff used best practice advisories and educational tools to guide test choices. The goal was to stop ordering two specific blood tests together when only one was needed. After the changes, the rate of ordering both tests dropped by thirty-four percent. Orders for the individual tests also went down significantly.

Departments that received both types of support saw the biggest improvement, with a drop of more than fifty-six percent in co-ordering. This suggests that simple reminders and training can help doctors choose tests more wisely. However, because this was not a randomized trial, other factors might have influenced the results.

No safety issues were reported during the study period. The findings suggest better test utilization might be possible in similar settings. Patients should discuss any concerns about test necessity with their own healthcare providers.

What this means for you:
Simple hospital tools helped reduce unnecessary inflammatory blood test orders among veterans in one study.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
It is widely recognized that the ESR (Erythrocyte Sedimentation Rate) and hs-CRP (C-Reactive Protein) are comparable inflammatory markers. In this reported veteran population, there is a significant correlation between the two assays. The simultaneous ordering of ESR and hs-CRP for evaluation of acute inflammation is unnecessary and wasteful. Various hospitals have implemented processes to reduce co-ordering habits through best practice advisories (BPAs) and/or educational interventions. In this retrospective study spanning twelve months, the Northern California Veteran Affairs Hospital System had a co-ordering rate of approximately 72% (number of hs-CRP orders with a co-ordered ESR compared to the total number of hs-CRP orders). After implementing a best practice ordering advisory and providing education to the clinical teams, there was a significant decrease in co-ordering of the assays (−34%, p-value = 0.00036). There was also a significant decrease in standalone ESR ordering and standalone hs-CRP ordering (p-value = 0.0003 and 0.0042, respectively). Departments receiving both interventions, an ordering advisory and education, had the largest decrease in co-ordering habits, the largest decrease seen being more than 56%. Proper implementation of ordering advisories paired with education results in better test utilization and lower co-ordering rates.
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