A Novel Approach to Improving Utilization of Laboratory Testing

Abstract

Context.-The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing.Objective.-To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population.Design.-We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P , .001).Results.-Our ''one-button'' order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis.Conclusions.-Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

An efficient machine learning-based approach for screening individuals at risk of hereditary haemochromatosis

“…We investigated the characteristics of the family study cohort, and as expected, HH cases had median serum ferritin and transferrin saturation levels above the reference levels used for HH diagnosis 23,24 . Commonly accepted reference ranges for females are 200 ng/mL, and 45%, for serum ferritin and transferrin saturation, respectively, and for males are 300 ng/mL, and 50%, for serum ferritin and transferrin saturation, respectively.…”

“…It has been reported that 80 to 85% of HH cases are HFE C282Y homozygous 1 . Furthermore, serum ferritin concentration and transferrin saturation are common first line diagnostic markers for HH 23,24 . These results demonstrate the validity of the feature ranking approach.…”

Optimization of Advanced Molecular Genetic Testing Utilization in Hematopathology: A Goldilocks Approach to Bone Marrow Testing

“…DSAs have helped optimize testing in a number of clinical settings. [4][5][6] The goal of our study was to demonstrate that use of DSA-supported test ordering after pathologist evaluation decreases unnecessary overordering and omitted testing.…”