Do We Know What Inappropriate Laboratory Utilization Is?

Walraven, Carl van; Naylor, C. David

doi:10.1001/jama.280.6.550

Cited by 313 publications

(91 citation statements)

References 118 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Gereksiz test istemleri, artan laboratuvar kullanı-mının en önemli nedenini oluşturmaktadır (11) (12) . Tüm bu nedenler test kullanımındaki artışa neden olsa da bu artıştaki en önemli pay gereksiz test istemlerince oluşturulmaktadır (11) .…”

Section: Discussionunclassified

See 1 more Smart Citation

An Example for Investigation of Unnecessary Laboratory Testing: Free PSA Test

Karakoyun¹,

Ayfer²,

Arslan³

et al. 2017

Terh

View full text Add to dashboard Cite

ÖZAmaç: Son yıllarda laboratuvar hizmetleri kullanımındaki artışın en önemli nedeni gereksiz test istemleridir. Hastanemizde istem yapılan tPSA ve sPSA testlerini inceleyerek, sPSA testi için gereksiz test istemini tPSA testi üzerinden değerlendirmeyi amaçladık. Yöntem: Hastanemizde 01.01.2011 ve 31.12.2015 tarihleri arasında istenen tPSA ve sPSA testlerini retrospektif olarak değerlendirdik. Hastadan ilk test isteminde tPSA'nın <4 ng/ml veya >10 ng/ml olması durumunda tPSA ile birlikte sPSA istendiyse bu sPSA istemlerini "gereksiz başlangıç test istemi" olarak değerlendirdik. Test istemlerinin yapıldığı bölümleri ve yıllara göre dağılımını incelendik. Bulgular: İstemi yapılan 9759 (78,8%) sPSA testinin "gereksiz test istemi" olduğunu saptadık. Bölümlere göre bir değerlendirme yapıldığında en fazla gereksiz test istem oranı olan polikliniğin nükleer tıp polikliniği (96,5%) olduğunu gördük. Servisler içinde en fazla gereksiz sPSA testi nöroloji servisi (90,6%) tarafından istenmiştir. Sonuç: Hastanemizde oluşturulan laboratuvar tetkik komisyonunca PSA istemi ile ilgili 2015 yılında kısıtlama getirilmesine rağmen, gereksiz test istem oranında istatistiksel olarak anlamlı bir değişiklik gözlenmedi (p>0,05). Laboratuvar maliyetlerinin klinisyenlerle paylaşılması, klinisyen eğitim programlarının arttırılması, test istemlerinde tanı algoritmalarının geliştirilmesi ve kullanımı gibi uygulamalar gereksiz test istemlerinin azaltılmasında etkili olabilir.Anahtar kelimeler: Prostat spesifik antijen, sağlık bakım maliyetleri, klinik laboratuvar hizmetleri ABSTRACT Objective: In recent years the main reason of the increase in the use of laboratory services is unnecessary laboratory testing. We aimed to investigate the unnecessary laboratory testing for fPSA test through tPSA test by examining the tPSA and fPSA tests which were ordered at our hospital. Methods: We evaluated the tPSA and fPSA tests retrospectively which were ordered at our hospital between 01.01.2011 and 31.12.2015. fPSA tests which were ordered simultaneously when tPSA test results were 4 ng/ml or greater than 10 ng/ml, were accepted as inappropriate initial testing. We investigated the departments that requested these tests and the distribution of these tests by years. Results: We determined that 9759 of fPSA tests (78.8%) were unnecessary laboratory testing. When evaluated according to the outpatient departments we determined that most frequently (95%) unnecessary laboratory tests was ordered by the polyclinics of nuclear medicine. While neurology service most frequently (90.6%) ordered unnecessary laboratory testing. Conclusion: Although the laboratory test commission imposed restrictions on the ordering of PSA tests in 2015, we haven't observed a statistically significant change in the frequency of unnecessary laboratory testing rate (p>0.05). The preventive measures as sharing information about the cost of laboratory tests with clinicians, increasing the number of clinician education programs, developing and using diagnostic algorithms for test ordering m...

show abstract

Section: Discussionunclassified

“…Tüm bu nedenler test kullanımındaki artışa neden olsa da bu artıştaki en önemli pay gereksiz test istemlerince oluşturulmaktadır (11) . Hastanemiz Bilgi İşlem Biriminden retrospektif olarak elde ettiğimiz verilerden yaptığımız çalışma-da, sPSA test istemlerini inceledik.…”

Section: Discussionunclassified

An Example for Investigation of Unnecessary Laboratory Testing: Free PSA Test

Karakoyun¹,

Ayfer²,

Arslan³

et al. 2017

Terh

View full text Add to dashboard Cite

show abstract

“…This can hasten healing and improve the quality of life of the patient, while avoiding inappropriate costs to the national health system and patient [21]. Many studies have explored the potential to avoid unnecessary costs resulting from inappropriate therapy [22][23][24], but this is the first that focuses on mycotic skin infections and cost savings that…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of inappropriate treatments for suspected dermatomycoses

Fiammenghi¹,

Patalano²,

Conte³

et al. 2015

View full text Add to dashboard Cite

Superficial mycoses are estimated to affect more than 20-25% of the world's population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1) to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2) to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital " Federico II") in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination) were defined as inappropriate: (1) cortisone in a patient with at least one positive site; (2) antifungals in (a) patients with all negative sites or (b) ineffective antifungal treatment (in terms of drug chosen, dose or duration) in those with all positive sites; or (3) antibiotics; (4) antivirals or (5) antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease with respect to the total consumption of drugs at the time of access to the Mycology Laboratory of € 34,781. Thus, our cost analysis shows that it is important to obtain a reduction of costs for pathologies that need to be confirmed by examinations before starting treatment.

show abstract

“…A systematic review of clinical laboratory audits found 5% to 50% of laboratory testing could be classified as inappropriate. 4 In the only published study of the appropriateness of a genetic test, 17% of APC tests for familial adenomatous polyposis were found to be requested for inappropriate indications. 5 The only previous report of DGT was included in a study of genetic testing in liver transplant patients where seven duplicate genetic tests were identified in a cohort of 215 patients.…”

Section: Discussionmentioning

confidence: 99%

The incidence of duplicate genetic testing

Riegert–Johnson

Macaya

Hefferon

et al. 2008

Genetics in Medicine

View full text Add to dashboard Cite

Purpose: Duplicate genetic testing (DGT) should give the same results as the initial genetic test. Therefore, DGT is indicated only in the rare instances where the initial results require confirmation. The objective of this study was to determine the incidence of DGT by reviewing TPMT, HFE, and CYP450 2D6 polymorphism testing performed in our institution's laboratories in 2006. A secondary objective was to determine the savings in charges that resulted from a system in place to limit HFE DGT. Methods: A retrospective records review at an academic medical center. Key Words: genetic testing, molecular diagnostic techniques, duplicate genetic testing, laboratory techniques and procedures, inappropriate laboratory utilizationMost genetic testing uses DNA extracted from peripheral blood lymphocytes. DNA extracted from these cells rarely changes during a person's lifetime, and a duplicate genetic test should give the same the results as the initial test. Therefore, duplicate genetic testing (DGT) is indicated only in the rare circumstances where the initial results require confirmation. Examples of appropriate indications for DGT include concern for switching of samples or when genetic testing results are unexpected and require confirmation. This is the first study of the incidence of DGT, specifically the incidence of duplicate HFE, TPMT, and CYP450 2D6 polymorphism genetic testing. Mutations in the HFE gene are associated with the iron overload disorder hemochromatosis. 1 The TPMT gene codes for the thiopurine S-methyl transferase enzyme, which is involved in metabolizing the immunosuppressant drug azathioprine. Clinicians use TPMT testing to identify patients who are poor metabolizers of azathioprine metabolites and are at high risk developing aziothioprine-related side effects. 2 CYP450 2D6 polymorphisms can predict a patient's response to therapy and the possibility of adverse reactions from antidepressants and other drugs metabolized by the CYP450 2D6 drug metabolism enzyme. 3 We reviewed all HFE testing and the majority of TPMT and internally referred CYP450 2D6 testing performed in Mayo Clinic laboratories in 2006 to determine the percentage of patients who had the same genetic test performed more than once in 2006. In addition, to determine the incidence of DGT over a longer period of time, we performed an all-time records review on a subset of consecutive patients from inside our institution that had HFE, TPMT, or CYP450 2D6 testing in 2006. To investigate whether the type of medical practice (academic vs. community) was associated with an increased incidence of DGT, we compared the incidence of DGT for HFE and TPMT testing in internal and external referral groups. The internal sample cohort consisted of patients seen in our institution's academic medical center practice, while the external sample cohort represented an admixture of samples referred from both academic and community-based practices.During the time this study was performed, the laboratory performing HFE testing had a system in place to limit...

show abstract

Do We Know What Inappropriate Laboratory Utilization Is?

Cited by 313 publications

References 118 publications

An Example for Investigation of Unnecessary Laboratory Testing: Free PSA Test

An Example for Investigation of Unnecessary Laboratory Testing: Free PSA Test

Cost analysis of inappropriate treatments for suspected dermatomycoses

The incidence of duplicate genetic testing

Contact Info

Product

Resources

About