Journal of Evaluation in Clinical Practice, 10, 4, 519–523 © 2004 Blackwell Publishing Ltd 519 Blackwell Science, LtdOxford, UKJEPJournal of Evaluation in Clinical Practice1365-2753Blackwell Publishing Ltd 200310 4519523Original ArticleApplication of hepatitis serology testing algorithmsO.A. Ozbek et al. Correspondence Dr Ozgen A. Ozbek Dokuz Eylul University Faculty of Medicine Inciralti 35340-Izmir Turkey Keywords: algorithms, diagnostic tests, forms and records control, unnecessary procedures, utilization review Accepted for publication: 1 July 2003 Application of hepatitis serology testing algorithms to assess inappropriate laboratory utilization Ozgen A. Ozbek MD, 1 Mehmet A. Oktem MD, 2 Guliz Dogan MD 3 and Yusuf H. Abacioglu MD 4 1 Specialist, Dokuz Eylul University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Inciralti, Izmir, Turkey 2 Assistant Professor, Dokuz Eylul University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Inciralti, Izmir, Turkey 3 Research Fellow, Dokuz Eylul University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Inciralti, Izmir, Turkey 4 Professor, Dokuz Eylul University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Inciralti, Izmir, Turkey Abstract Rationale, aims and objectives Many studies pointed out inappropriate utilization of laboratory caused by excessive amounts of tests ordered by doctors. To prevent and to eliminate the ordering of unhelpful tests, intro- ducing diagnostic algorithms, which are also a suitable practice for applica- tion to hepatitis serology, have been suggested. This study aimed to determine inappropriate test ordering rates with respect to the commonly approved algorithms for serological diagnosis of viral hepatitis. Methods To assess the number of inappropriate test orders, laboratory records of samples sent for hepatitis A, B, and D serology were reviewed and evalu- ated retrospectively with respect to algorithms for serological diagnosis of viral hepatitis. Orders including serological marker groups with inadequate clinical information to determine whether or not the order was inappropri- ate were excluded from the analysis. Results Application of diagnostic algorithms showed that 50% of anti-HAV IgM and anti-HAV total; 12.7% of anti-HBs, 12.7% of anti-HBc total, 78.5% of anti-HBc IgM, 87.3% of HBe Ag, 78.8% of anti-HBe, 58.7% of anti-HD total orders were made inappropriately. Conclusions Our study provides information for inappro- priate laboratory utilization for hepatitis serology testing and we suggest to use diagnostic algorithms applied by the serology laboratory to decrease the rate of unhelpful test orders. Introduction Increase in the utilization of diagnostic tests raised concerns about the appropriate use of laboratory (Winkens & Dinant 2002). Search of literature reveals many studies pointing out inappropriate test ordering practices of doctors, causing excessive laboratory costs (Durand-Zaleski et al. 1993; Pilon et al. 1997; Merlani et al. 2001). To prevent and to eliminate the ordering of unhelpful tests, redesigning of requisition forms (Emerson & Emerson 2001), providing price information (Hampers et al. 1999), educational inter- ventions (Mozes et al. 1989) and introducing diagnos- tic algorithms (Pilon et al. 1997) have been suggested. Hepatitis serology is a suitable test group for appli- cation of diagnostic algorithms, as the combination of