Development of a Laboratory Alert Model to Reduce Medical Laboratory Expenditure in Kalasin Province

Abstract

Purposes : To study the situation of medical laboratory testing, develop an alert model, and evaluate the outcomes of the alert model for reducing wasteful medical laboratory expenditure in Kalasin Province.

Study design : Action research is based on the concepts of Kemmis & McTaggart, which comprise four stages: (1) Planning, (2) Action, (3) Observation, and (4) Reflection.

Materials and Methods : The sample consisted of 30 key informants, comprising physicians, medical technologists, medical scientists, medical science technical officers, computer scientists, and personnel responsible for related operations. Participants were selected using purposive sampling. The study was conducted between October 2024 and September 2025. Data were collected through in-depth interviews, focus group discussions, and a satisfaction assessment questionnaire. Quantitative data were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation (SD.), while qualitative data were analyzed using content analysis.

Main findings : (1) Situation Analysis: The study found that there were 5,369 instances of redundant or unnecessary bundled laboratory test orders across 18 hospitals, resulting in a wasteful expenditure of 527,810 Baht. Furthermore, a lack of clear alert systems to prevent repetitive ordering during clinical practice was identified, negatively impacting the efficiency of laboratory resource management according to Rational Laboratory Use (RLU) policies. Consequently, there was an urgent need to develop an alert model to reduce wasteful expenditure that is concrete and aligned with the local context. (2) Laboratory Alert Model: The developed model for reducing wasteful laboratory expenditure in Kalasin Province consists of eight components: 1) establishing a steering committee to oversee operations; 2) analyzing the situation and costs of medical laboratory testing; 3) defining measures/guidelines to reduce overutilization and underutilization and announcing provincial-level policies; 4) formulating action plans; 5) developing an alert system to reduce wasteful expenditure; 6) monitoring and evaluating implementation; 7) assessing outcomes following model development; and 8) organizing a lesson-learned and data feedback session.  Following the implementation of the model, the number of repetitive HbA1c tests ordered within 90 days decreased by 2,081 instances (38.76%), and the cost of wasteful expenditure from repetitive HbA1c testing within 90 days was reduced by 202,364 Baht compared to the fiscal year 2024. Additionally, healthcare personnel reported a high level of satisfaction with the alert model, with an average score of 4.13 (SD. = 0.11).

Conclusion and recommendations : In conclusion, laboratory alerting systems represent a promising intervention to assist clinicians in reducing unnecessary test ordering, particularly the repetitive ordering of HbA1c tests in patients with diabetes mellitus, thereby contributing to a significant reduction in unnecessary laboratory expenditure.