Computer-based-limited and personalised education management maximise appropriateness of vitamin D, vitamin B12 and folate retesting

Pelloso, Michela; Basso, Daniela; Padoan, Andrea; Fogar, Paola; Plebani, Mario

doi:10.1136/jclinpath-2015-203447

Cited by 25 publications

(12 citation statements)

References 26 publications

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“…In patients without diabetes and normal HbA 1c values, testing should be repeated at a minimum of 3-year interval [4]. Similar guidelines are available for the recommended intervals of repeat testing of many other laboratory parameters [44,45].…”

Section: A Re-testing Intervalsmentioning

confidence: 99%

Managing inappropriate utilization of laboratory resources

et al. 2018

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Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources.

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Section: A Re-testing Intervalsmentioning

confidence: 99%

Managing inappropriate utilization of laboratory resources

et al. 2018

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“…Our study did not utilize a hard stop, which has been shown to be effective in reducing inappropriate vitamin D testing. 13,[15][16][17] By simply alerting a provider that a test may be inappropriate, our alert served as a soft stop, likely accounting for the limited efficacy despite using a more specific trigger for displaying the alert than has been reported previously. 4.…”

Section: Discussionmentioning

confidence: 95%

“…15,16 An inpatient alert in one report increased appropriate retesting of vitamin D from 40 to 64% by alerting providers if the vitamin D level had been checked recently. 17 Our study used a different method, with providers, receiving an alert only if the patient did not have an appropriate diagnosis for the ordering of vitamin D testing.…”

Section: Discussionmentioning

confidence: 99%

“…6 Researchers lowered inappropriate vitamin D testing through reminding providers of vitamin D testing guidelines, 13,14 by requiring providers to select an approved indication for testing to proceed, 15,16 and by alerting providers if vitamin D testing had recently occurred. 17 We hypothesized that a sophisticated CDS that suppresses vitamin D testing alerts based on the diagnoses from the patient's chart would reduce inappropriate vitamin D testing.…”

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confidence: 99%

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Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

et al. 2020

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Background Despite guideline recommendations, vitamin D testing has increased substantially. Clinical decision support (CDS) presents an opportunity to reduce inappropriate laboratory testing. Objectives and Methods To reduce inappropriate testing of vitamin D at the Vanderbilt University Medical Center, a CDS assigned providers to receive or not receive an electronic alert each time a 25-hydroxyvitamin D assay was ordered for an adult patient unless the order was associated with a diagnosis in the patient's chart for which vitamin D testing is recommended. The CDS ran for 80 days, collecting data on number of tests, provider information, and basic patient demographics. Results During the 80 days, providers placed 12,368 orders for 25-hydroxyvitamin D. The intervention group ordered a vitamin D assay and received the alert for potentially inappropriate testing 2,181 times and completed the 25-hydroxyvitamin D order in 89.9% of encounters, while the control group ordered a vitamin D assay (without receiving an alert) 2,032 times and completed the order in 98.1% of encounters, for an absolute reduction of testing of 8% (p < 0.001). Conclusion This CDS reduced vitamin D ordering by utilizing a soft-stop approach. At a charge of $179.00 per test and a cost to the laboratory of $4.20 per test, each display of the alert led to an average reduction of $14.70 in charges and of $0.34 in spending by the laboratory (the savings/alert ratio). By describing the effectiveness of an electronic alert in terms of the savings/alert ratio, the impact of this intervention can be better appreciated and compared with other interventions.

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“…We should emphasize that the effectiveness of the test is maximized when oriented to subjects suggestive or at risk for deficiency and low or absent when used as tool for screening or serial monitoring of vitamin intake or supplementation. In the latter case, to prevent retesting, a computer-based-limiting management strategy may be considered [95]. Finally, we should be aware that the recent recalibration of several commercial assays in view of harmonization policies is likely significantly shifting results and, if not correctly managed, potentially affecting the detection of folate deficiency in individuals at risk.…”

Section: Discussionmentioning

confidence: 99%

Tackling serum folate test in European countries within the health technology assessment paradigm: request appropriateness, assays and health outcomes

Ferraro

Panzeri

Panteghini

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Several authors have recently claimed an excess in serum folate test ordering, suggesting phasing out it from clinical use. According to studies performed in countries undergoing folic acid fortification policies, it is indeed no more cost-effective to test folate in the face of deficiency prevalence < 1%. In this paper, we sought to evaluate request appropriateness, analytical issues, and cost-effectiveness of serum folate determination for clinical purposes in the European context, considering if evidence retrieved in fortified countries may be generalized. Studies performed in non-fortified countries have generally reported a suboptimal folate intake and suggest a remarkable prevalence of folate deficiency. Our internal data suggest that ~ 20%-25% of the subjects undergoing serum folate test are at risk for deficiency. However, a reliable evaluation of the risk for deficiency implies the knowledge of all issues related to the total testing process of folate measurement as well as the identification of the appropriate population in which to perform the test. The cost-effectiveness of the test is maximized when the request is oriented to subjects suggestive/at risk for deficiency, becoming low if the test is used as a screening tool or for monitoring of vitamin intake/supplementation. Because the individual folate status has a key role in ensuring normal development, physiologic growth, and maintenance of optimal health, the evaluation of its serum levels has to be retained in the clinical use in non-fortified countries, boosting for more appropriate request, and evidence from countries following fortification policies should be cautionary interpreted.

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Computer-based-limited and personalised education management maximise appropriateness of vitamin D, vitamin B12 and folate retesting

Abstract: Laboratory demand management based on an IT-limiting management strategy or on education of the referring physicians appears helpful in maximising appropriate retesting.

Cited by 25 publications

References 26 publications

Managing inappropriate utilization of laboratory resources

Managing inappropriate utilization of laboratory resources

Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

Tackling serum folate test in European countries within the health technology assessment paradigm: request appropriateness, assays and health outcomes

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