PRObalistic Method of Prompting for Test ORdering for Family Medicine

PROMPTOR-FM is a prompting system for test ordering uniquely tailored to each patient's situation. It's features are:

• rapidly displays the positive and negative predictive values of a test based on one's clinical index of suspicion of disease,
• displays the meaning of a positive and negative test result prior to the physician actually ordering the test,
• incorporates a guidance system for pre-test likelihood of disease based on currently available evidence in the medical literature about characteristics of individual laboratory tests,
• allows the physician to repeat calculations of the same test and compare results with previous calculations.

Laboratory tests and procedures are usually ordered for the following reasons:

• Screening
• In suspicion of disease and to help diagnose disease (case-finding)
• To follow-up abnormal lab results (repeating tests to monitor disease)
• For patient reassurance

PROMPTOR-FM is are designed to help with making a decision regarding the use of tests for the first two, SCREENING and CASE-FINDING.

It is NOT intended to help with decisions for monitoring the progress of disease. Disease monitoring does not depend on probabilities.

Patient reassurance is a legitimate reason for ordering a test especially if the cost of testing is less than the costs of repeated visits for reassurance.

PROMPTOR-FM has been tested in a randomized controlled clinical trial in an academic family medicine center using clinical vignettes with first and second year residents. There was a 38% decrease in the numbers of tests ordered (p<.01) and a 12% decrease in the costs of tests ordered by using the prompting system. When used at the point of the patient encounter, this system has the potential for promoting more appropriate test ordering and for saving considerable health care dollars.