A total of 2,185 papers were confirmed (FIG. 1). After reviewing the title, 2,161 articles were excluded, 91 of which were copies. Twenty articles were reviewed by the entire text, except for 18 articles (10 are non -Europeans other than Europe and eight were considered arbitration). Following the entire text review, two articles were included. Through the reference list review, three additional articles will be included, bringing the final number to five articles.
Learning characteristics
Two of the five studies were performed in Sweden 11, 12, Belgium 13, the Netherlands 14, and France (Table 2) (Table 2). One study was conducted in the first division (14), and three were performed in the secondary sector (2 emergency rooms 12, 13), the intensive care unit 15, and one section 11.
One study was less than 500 patients (15), the two studies had an intermediate sample -sized patient (12, 13), and the two largest studies were estimated to have been estimated to be more than 5,000 patients (11, 14). All studies used the preliminary post mediation effect, and one study had an additional follow -up period after the price label (13). One study has a control (12). In four studies, only the price labeled only when ordering (12,,,13,,,1415) One study included the price indicator when ordering the price and the results of the sample of individual patients (11).
The four studies performed other interventions with the price mark for the laboratory test. At the same time, the three studies showed the price of clinical video prices (12, 13, 15), and one study changed the billing method for the laboratory test after introducing the price label (11). This change in the billing method meant that the medical center went to the full payments from paying a small number of laboratory test prices.
The three studies have a two -month (12, 13, 15) intervention period, and one study lasts to 13 months (13) and other studies to 13 months (13). Regarding the effective measurement, the two studies measured the effects of intervention in terms of the number of laboratory tests 13 and 14, and both studies measured in the laboratory test costs 12 and 13 and the single study examine both aspects (15).
Reduction of test number and cost
All five studies reported that the number of tests and/or the costs for them decreased, but only four studies showed statistically significant effects (11, 13,,,1415) (Table 3).
The three studies evaluated the effects of arbitration in the number of laboratory tests performed. The biggest reduction in the number of tests is Seguin et al. (15) Observation of 18.4% reduction; But we are not statistically significant. Muris et al. (14) observed a small reduction of 6.1%. Ekblom et al. (11) As a result of analyzing the impact of the first and second sectors within the first sector, the price labeling reduced the price label in the first and second sectors, while the publicly operated practice showed 0.11 testimony (approximately 3.9%) per consultation. In the second sector, a 0.34 test decreased per consultation was found (about -3.7%). Nougon et al. (13) I collected data in the third period after intervention (after the price mark). During this third period, laboratory test costs were reduced by 5.02% compared to the previous period of arbitration.
Three studies have shown the effects of intervention on laboratory test costs. Seguin et al. (15) showed the most practical effect by observing the decrease in the laboratory test cost by 22%. Schilling et al. (12) reported a similar reduction of 21.4%. But Nougon et al. (13) found a reduction in costs of 10.7%.
Learning quality evaluation
This study was evaluated as an average of 14.8 points (12 to 17 points) in the modified down and black checklists (see Quality Evaluation Details of individual studies of Appendix 1) (Table 4).
Research was generally difficult with the same weakness. After intervention and intervention, the group was not recruited at the same time, which could potentially expose the annual and seasonal diseases, which can lead to another requirement for laboratory inspection. In addition, the patient was not randomized, and the study did not report unintended events due to mediation and did not control the chaos.
Seguin et al. (15) was considered the highest quality with 17 points. In particular, this study was the only study that deals with chaos before and after intervention. The study attempted to avoid various degrees in the group before and after arbitration. All studies are carried out in the same primary medical center before and after the same hospital department and/or intervention, so the patient is likely to belong to the same population. However, research designs with intervention and post -periods can be a problem in terms of annual and seasonal changes such as disease, new guidelines, media reports, and busy. This approach can still face the annual deformation, but it explains another important factor. Morgan et al. (16)
In studies such as Seguin. (15) The main results selected were “laboratory test costs” and “number of hospitals per hospital.” However, the average hospitalization length decreased from 10 days before intervention to 7 days after intervention, which decreased by 30%. However, as a result of the 22% decrease in laboratory test costs per hospital, the result of decreasing 18.4% per hospital seems to be low reliability.
Simultaneous intervention was a potential pollutant in four studies. In the three studies, simultaneous intervention included displaying a video test price (12, 13, 15). This can increase the perception of continuous intervention, but the actual impact on the results of this simultaneous intervention can be limited. Ekblom et al. Simultaneous interventions consisted of changes in the payment method, and the primary medical centers proceeded from partially dealing with laboratory test costs (11). The price label was implemented for four months, which was replaced by a changed payment method. In other words, the two arbitration did not occur at the same time, so the price indicator will not be affected by the changed payment method.
Another possible confusion in three studies (12, 13, 15) was a short intervention period. In a study of short intervention periods (2 months), we observed a tendency (10.7-22%) (10.7-22%), which is 3.7-6.1%less than the two studies of interventions (14) and up to 13 months (11). Thus, the shorter intervention period can exaggerate the impact of intervention.
Another factor that can increase the quality of research is the presence of the control group. Schilling et al. (12) was the only study in this review, including a doctor’s non -exposed control group. However, this control group was part of the same emergency room as the arbitration group, and there is a risk of pollution between groups. In addition, changes in the management change of accounting methods can occur simultaneously with intervention, making the laboratory cost of the control group incomprehensively. In addition, since the result of intervention was calculated independently of the control group, the control group did not construct a valuable part of the study.
