Introduction/Objective Benchmarking establishes baseline laboratory utilization patterns across health systems. Nicholas et al. (2021) recently evaluated the use of test volume ratios to identify utilization intervention targets at VA hospitals. We aim to investigate potential differences of reported test volume ratios with those of non-VA hospitals. Methods/Case Report Using the Vizient® Clinical Data Base with permission from Vizient, Inc. (All rights reserved.), we obtained aggregated annual test and patient volumes from 2019-2021. To assess the accuracy of high-volume tests as a surrogate for patient volumes, we compared mean annual sodium and MCV test volumes with mean annual number of patient encounters at 712 hospitals (7,685,149 mean annual patient volume). We then calculated test volume ratios for eight less common analytes (homocysteine, prolactin, vitamin D (25-OH), HCV viral load, HIV viral load, Lyme disease serology, CD4, and HSV serology) at hospitals with patient encounters greater than 10,000 (279 hospitals, 6,046,670 mean annual patient volume). We calculated ratios using mean annual number of 1) sodium tests and 2) patient encounters as the denominator for comparison to reported ratios. All analytes are included in Choosing Wisely™ guidelines. Results (if a Case Study enter NA) There was strong positive correlation between mean annual sodium and MCV test volumes and mean annual patient volume (R = 0.92 and R=0.96, respectively). Our analyte-to-sodium volume ratios were smaller than expected. However, the analyte-to-patient volume median ratios were similar to those reported. A comparison of the calculated ratios showed a strong positive correlation (R=0.90), but the sodium ratios were nearly 4x smaller than the patient volume ratios. On average, the two methods agreed nearly 70% of the time for institutions with ratios greater than the 90th percentile- the intervention threshold. In comparison to previously reported median ratios, five analytes (homocysteine, prolactin, vitamin D (25-OH), Lyme disease serology and HSV serology) showed a significant difference from previously published ratios. Conclusion In comparison to VA hospitals, significant differences in median ratios were found. For calculating test volume ratios, high-volume tests are an adequate surrogate for patient volumes but may pose a challenge for inter- institution comparisons. Standardization for quantifying high-volume tests would improve the use of test volume ratios for benchmarking.
Introduction/Objective Evaluation of obstetric clinical laboratory test utilization differences between academic and non-academic health systems would provide important benchmarking information for healthcare leaders and policy makers. Methods/Case Report Over a 3-year period (2019-2021), using the Vizient® Clinical Data Base with permission from Vizient, Inc. (All rights reserved.), we compared clinical laboratory utilization for adult obstetrics inpatients at mid-size (250-450 hospital beds) academic (N=9; 27,036 hospitalizations) and non-academic (N=17; 50,462 hospitalizations) hospitals across the US. We used Medicare Severity Diagnosis Related Groups (MSDRG), employed by the US Centers for Medicare and Medicaid Services (CMS), to identify Cesarean section (MSDRG triplet 786-788) and vaginal delivery (MSDGR triplet 805-807) patient groups. For both groups, we stratified by comorbid conditions and complications into high, moderate, and low severity subgroups. We compared the mean number of laboratory tests (CPT codes 80000-89999) per hospitalization and per hospital day. We measured aggregate Clinical Resource Intensity Weight (RIW) per hospitalization to quantify laboratory resource consumption for each encounter. The RIW is based on the CMS Ambulatory Payment Classification (APC) weights. Results (if a Case Study enter NA) Academic hospitals had a significantly (p<.01) higher mean number of lab tests per Cesarean section hospitalization (20.3 vs. 10.3 tests, 97.1% higher) and hospital day (4.7 vs. 3.3 tests, 42.4% higher). Laboratory RIW per case was also significantly (p<.01) higher at academic hospitals (4.8 vs. 3.6 RIW, 33.3% higher); however, RIW per day did not differ between academic and non-academic hospitals. Significant differences (p<.01) persisted after adjusting for severity level. Although differences were smaller, academic hospitals had greater lab tests per case (12.1 vs. 8.1 tests, 49.4% higher) and day (4.3 vs. 3.6 tests, 19.4% higher) for vaginal delivery hospitalizations. Laboratory RIW per case was also significantly (p<.01) higher at academic hospitals (3.4 vs. 2.8 RIW, 21.4% higher). Laboratory RIW per day did not differ significantly. Significant differences remained for the high and moderate severity vaginal delivery groups. Conclusion Academic hospitals have greater laboratory test utilization for obstetrics patients. This difference appears to be largely due to a longer mean length of stay as well as use of tests with higher RIW.
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