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Feasibility and cost efficiency of a diagnostic guideline for chronic polyneuropathy: a prospective implementation study

¹ The Rudolf Magnus Institute of Neuroscience, Department of Neurology, University Medical Centre Utrecht, Heidelberglaan 100 3584 CX Utrecht, The Netherlands
² The Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht
³ The Rudolf Magnus Institute of Neuroscience, Department of Clinical Neurophysiology, University Medical Centre Utrecht
⁴ Academic Medical Centre, Department of Neurology, University of Amsterdam, 1100 DE Amsterdam, The Netherlands

Correspondence to:
Correspondence to:
Dr A F J E Vrancken
University Medical Centre Utrecht, Department of Neurology C03.236, Heidelberglaan 100 3584 CX Utrecht, The Netherlands; a.f.j.e.vrancken{at}umcutrecht.nl

ABSTRACT
Background: Extensive investigations are often performed to reveal the cause of chronic polyneuropathy. It is not known whether a restrictive diagnostic guideline improves cost efficiency without loss of diagnostic reliability.

Methods: In a prospective multicentre study, a comparison was made between the workup in patients with chronic polyneuropathy before and after guideline implementation.

Results: Three hundred and ten patients were included: 173 before and 137 after guideline implementation. In all patients, the diagnosis would remain the same if the workup was limited to the investigations in the guideline. After guideline implementation, the time to reach a diagnosis decreased by two weeks. There was a reduction of 33% in the number and costs of routine laboratory investigations/patient, and a reduction of 27% in the total number of laboratory tests/patient, despite low guideline adherence.

Conclusion: The implementation of a diagnostic guideline for chronic polyneuropathy can reduce diagnostic delay and the number and costs of investigations for each patient without loss of diagnostic reliability. Continuous evaluation strategies after guideline implementation may improve guideline adherence and cost efficiency.

Keywords: polyneuropathies; diagnosis; diagnostic tests; clinical practice guideline; guideline adherence