Most GI groups don’t have a breath-testing problem. They have a breath-testing program problem.
Kits get ordered. Curves come back, some of the time. Turnaround is “fine.” But ask a harder question — what is breath testing actually doing for our patients, providers, and practice? — and the answers get fuzzy.
If that sounds familiar, it’s a sign your practice is still operating a kit model rather than a program model. What follows is a practical blueprint, adapted from the Breath Testing Done Right eBook, for making the shift.
The short answer
A kit model optimizes individual tests. A program model optimizes the pathway: order, register, prepare, collect, return, analyze, act. Moving from one to the other takes six steps — define why breath testing exists in your group, map the pathway honestly, layer in the four program domains, pick one entry point instead of a full overhaul, make three program metrics visible, and decide what “program, not kit” means for your environment.
14 statements. 10–15 minutes. Works for any testing model.
The distinction
Two ways to run the same test
- Optimizes the individual test
- Success is measured by kits ordered
- Handoffs are improvised by whoever is available
- Prep and timing vary by provider
- Nobody owns unreturned kits
- Economic picture is unexamined
- Optimizes the full order-to-action pathway
- Success is measured by completed tests that change a plan
- Each handoff has a documented owner
- One protocol per test type across every site
- Follow-up on unreturned kits is assigned
- Completion, turnaround, and yield are tracked
Start with a clear “why”
Why does breath testing exist in our GI group?
Answer that before touching protocols or vendors. High-performing programs tend to give one of four answers:
- To clarify small-bowel contributions to IBS-like presentations
- To protect clinic capacity by avoiding repeat visits and unproductive workups
- To standardize how suspected SIBO and IMO are evaluated across providers and sites
- To support referrals from primary care, endocrinology, rheumatology, dermatology, and pediatrics with a consistent diagnostic experience
If your current answer is closer to “it’s what we’ve always done” or “patients expect it,” that’s the first thing to rewrite. Every other design choice flows from this one.
Map your current pathway honestly
A kit model focuses on individual tests. A program model focuses on the pathway — and every breath testing setup, in-clinic or at-home, runs on the same seven links.
The HMBT pathway
Order to action, in seven links
Order. How easy is it for a provider to place one?
Register. How consistently do kits get tied to the right patient?
Prepare. How clear and consistent are prep instructions across providers?
Return. Who owns follow-up on unreturned kits?
Act. How do results reach the provider, and how often do they lead to a documented change in plan?
Take 10 to 15 minutes with your team and walk each step. Most groups discover they don’t have a breath-testing workflow so much as a series of handoffs everyone is improvising their way through. That’s what you’re going to fix.
Layer in the four program domains
In the BTDR framework, a healthy hydrogen and methane breath testing program stands on four domains. Once your pathway is mapped, overlay them and mark where each one is holding and where it’s leaking.
The four domains
What to look for at each point in the pathway
Watch for: no CO₂ checks, unclear sample stability, inconsistent guideline alignment.
Watch for: different prep across providers, timing shortcuts, substrate chosen by habit.
Watch for: poor kit registration, low return ratio, long turnaround time.
Watch for: lots of kits, few completed episodes of care.
You don’t need perfect data on day one. You need enough truth to see where you’re running a program and where you’re still just shipping kits.
The self-assessment turns this overlay into a number you can bring to a meeting.
Pick an entry point, not a total overhaul
The fastest way to not improve your program is to try to fix everything at once. Choose one of three entry points.
Three entry points
Pick the one that matches your weakest domain
- Tighten prep, substrate, and timing
- Align positivity criteria with current guidelines
- Make sure every provider understands and trusts the model
Choose when providers quietly distrust the curves.
- Baseline return ratio and turnaround time
- Clean up kit registration and tracking
- Reduce staff time spent chasing missing kits
Choose when kits go out and don’t come back.
- Run a small pilot with a different model
- Prove out completion, turnaround, and economics
- Compare against your current baseline
Choose when the setup itself is mismatched to your goals.
The goal is a 90-day experiment, not a five-year plan.
Make program metrics visible
High-yield programs don’t just feel better. They measure better. Three numbers are the minimum.
The three minimum metrics
What to put on a shared sheet this month
How much of your ordering effort becomes usable clinical data.
Whether results arrive in time to change the next visit.
Medication, diet, follow-up, additional workup, or documented reassurance. The metric most programs never track.
You don’t need a dashboard vendor to start. A shared sheet with these three numbers by month and by site is enough to see progress and to spot where you’re still losing patients or time. If you want the detail behind the first one, we walk through it in understanding return ratio.
Decide what “program, not kit” means for your group
At the end of this process, you should be able to answer three questions:
-
What job do we want breath testing to do in our GI pathway?
Written down, in one sentence, agreed by the people who order the tests.
-
What model best supports that job in our environment?
In-clinic, at-home, or a programmatic partnership — judged against your capacity, geography, and staffing, not against a price list.
-
How will we know the program is working 6 to 12 months from now?
Named metrics, a named owner, and a date on the calendar to look at them.
For some groups, the answer means upgrading from an underperforming kit vendor to a programmatic partner with higher completion and faster turnaround. For others, it means redesigning internal workflows so existing testing finally pulls its weight. Either way, the shift is the same.
From “we do breath testing”
to “we run a breath-testing program that protects patients, providers, and the business.”
Blueprint FAQs
What is the difference between a kit model and a program model?
A kit model optimizes individual tests and measures success by kits ordered. A program model optimizes the whole pathway — order, register, prepare, collect, return, analyze, act — and measures success by completed tests that lead to a documented change in a patient’s care plan. The test itself is identical. What changes is the reliability of everything around it.
What are the seven steps of the HMBT pathway?
Order, register, prepare, collect, return, analyze, act. Every breath testing setup runs on this chain, whether testing happens in-clinic or at home. High-yield programs don’t change the chain; they improve the reliability of each link.
What are the four domains of a breath testing program?
Clinical integrity (do we trust the results), protocol integrity (is each test getting a fair chance to be interpretable), operational performance (can we reliably move from order to result to action), and economic yield (is the program creating the value it should). Each builds on the one before it.
Which metrics should a GI practice track for breath testing?
Three at minimum. Return ratio is completed tests divided by kits sent. Turnaround time runs from sample receipt to the result reaching the provider. Completion to care action is the share of completed tests that produce a documented change in plan — medication, diet, follow-up, additional workup, or reassurance. A shared sheet by month and site is enough to start.
Where should we start if everything needs improving?
Pick one entry point rather than attempting a full overhaul. A clinical and protocol tune-up suits practices where providers quietly distrust the curves. An operational tune-up suits practices where kits go out and don’t come back. A model pilot suits practices whose current setup is fundamentally mismatched to their goals. Aim for a 90-day experiment, not a five-year plan.
Do we have to change vendors to run a program model?
No. For some groups the answer is upgrading from an underperforming kit vendor to a programmatic partner with higher completion and faster turnaround. For others it means redesigning internal workflows so existing testing finally pulls its weight. The blueprint is vendor-neutral by design.
How long does it take to see a difference?
Plan in 90-day cycles. Baseline your metrics, change one thing in one domain, then recheck the same numbers at the end of the quarter. Groups that try to fix all four domains at once usually finish the year unable to say what worked.
Where to go next
If you want a structured way to score your current program before making changes, start with the Breath Testing Program Self-Assessment. It takes 10 to 15 minutes and returns a domain-by-domain view of where you’re strong, mixed, or high-opportunity.
Breath Testing Done Right
Go deeper into the four domains
Forty-five pages walking through each step in detail — with example questions for your vendor, the metrics that matter, and a comparison of the breath-testing models GI groups are using today.
