Journal of General Internal Medicine

, Volume 33, Issue 10, pp 1639–1645 | Cite as

Effect of Social Comparison Feedback on Laboratory Test Ordering for Hospitalized Patients: A Randomized Controlled Trial

  • Kira Ryskina
  • C. Jessica Dine
  • Yevgeniy Gitelman
  • Damien Leri
  • Mitesh Patel
  • Gregory Kurtzman
  • Lisa Y. Lin
  • Andrew J. Epstein
Original Research



Social comparison feedback is an increasingly popular strategy that uses performance report cards to modify physician behavior. Our objective was to test the effect of such feedback on the ordering of routine laboratory tests for hospitalized patients, a practice considered overused.


This was a single-blinded randomized controlled trial. Between January and June 2016, physicians on six general medicine teams at the Hospital of the University of Pennsylvania were cluster randomized with equal allocation to two arms: (1) those e-mailed a summary of their routine laboratory test ordering vs. the service average for the prior week, linked to a continuously updated personalized dashboard containing patient-level details, and snapshot of the dashboard and (2) those who did not receive the intervention. The primary outcome was the count of routine laboratory test orders placed by a physician per patient-day. We modeled the count of orders by each physician per patient-day after the intervention as a function of trial arm and the physician’s order count before the intervention. The count outcome was modeled using negative binomial models with adjustment for clustering within teams.


One hundred and fourteen interns and residents participated. We did not observe a statistically significant difference in adjusted reduction in routine laboratory ordering between the intervention and control physicians (physicians in the intervention group ordered 0.14 fewer tests per patient-day than physicians in the control group, 95% CI − 0.56 to 0.27, p = 0.50). Physicians whose absolute ordering rate deviated from the peer rate by more than 1.0 laboratory test per patient-day reduced their laboratory ordering by 0.80 orders per patient-day (95% CI − 1.58 to − 0.02, p = 0.04).


Personalized social comparison feedback on routine laboratory ordering did not change targeted behavior among physicians, although there was a significant decrease in orders among participants who deviated more from the peer rate.

Trial registration registration: #NCT02330289.


Funding Information

This work was supported in part by Career Development Award K08AG052572 (Dr. Ryskina) and the Matt Slap Pilot Research Award from the Division of General Internal Medicine at Perelman School of Medicine at the University of Pennsylvania.

Compliance with Ethical Standards

The University of Pennsylvania Institutional Review Board reviewed and approved this study with a waiver of written documentation of consent

Conflict of Interest

Mitesh Patel is principal at Catalyst Health, a technology and behavior change consulting firm, and an advisory board member at Healthmine Services Inc. and All other authors declare that they have no conflict of interest.

Supplementary material

11606_2018_4482_MOESM1_ESM.docx (694 kb)
ESM 1 (DOCX 694 kb)


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Kira Ryskina
    • 1
    • 2
  • C. Jessica Dine
    • 2
    • 3
  • Yevgeniy Gitelman
    • 4
    • 5
  • Damien Leri
    • 4
  • Mitesh Patel
    • 1
    • 2
    • 4
    • 5
  • Gregory Kurtzman
    • 1
  • Lisa Y. Lin
    • 1
  • Andrew J. Epstein
    • 1
    • 2
    • 5
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  2. 2.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Division of Pulmonary and Critical Care, Department of MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  4. 4.Penn Medicine Center for Health Care InnovationPhiladelphiaUSA
  5. 5.Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaUSA

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