Why are investigations not recommended by practice guidelines ordered at the periodic health examination?
Bibliographic record
Abstract
Evidence-based guidelines recommend few routine investigations for healthy adults at the periodic health examination (PHE). However, small studies indicate that laboratory tests are commonly ordered at the PHE. This study examined PHE laboratory testing that is not recommended by recognized guidelines ('discretionary'). Using administrative data from the universal health care system in Ontario, Canada, we studied 792,844 adults having a PHE in 1996 and the 3,727 physicians who administered them. We measured the number of discretionary laboratory tests per PHE along with the patient and physician factors potentially influencing laboratory testing. A multilevel, multivariate model was used to examine the association between the number of discretionary laboratory tests at the PHE with patient and physician characteristics. A mean of 7.1 discretionary tests (SD 7.1) was ordered per PHE. Renal, haematological, glucose and lipid tests each were conducted in more than a third of PHEs. Testing varied extensively between physicians and was more common in healthy patients. With the exception of age, patient factors had little effect on discretionary testing. However, each physician factor we examined was independently associated with the number of discretionary tests. Physician specialty, practice volume and previous testing patterns had the strongest influence on discretionary testing. Discretionary investigations are common at the PHE. Testing varies extensively between physicians and seems to be driven more by physician than by patient factors. Interventions to modify discretionary test utilization at the PHE should consider these physician factors.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.109 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".