Indicators of inappropriate tumour marker use through the mining of electronic health records

Gion, Massimo; Cardinali, Giulia; Trevisiol, Chiara; Zappa, Marco; Rainato, Giulia; Fabricio, Aline S C

doi:10.1111/jep.12754

Cited by 8 publications

(14 citation statements)

References 22 publications

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“…In contrast, Zhi et al reported that inappropriateness of laboratory tests ordering did not show significant variations over a similar time period (5). Published data on tumour markers confirm that no significant improvement of test ordering appropriateness occurred over the last years (15,17,19,20,(23)(24)(25)(26)(27). These findings support the hypothesis that recommendation of CPGs on tumour markers are largely disregarded and the process of knowledge translation presents on the whole significant margins for improvement.…”

Section: Discussionmentioning

confidence: 89%

“…However, the developed epidemiological-based model does not provide a direct measure of appropriateness, since it reveals areas of overutilization probably related to inappropriate use, in which it is necessary to confirm the inappropriateness through a deeper analysis. Our group developed a complementary methodological approach to deeply examine the inappropriateness of tumour markers ordering in outpatients (20). The method was based on the formulation of performance indicators which were tested by mining cohort-wide structured information in the electronic health records (EHRs) of the Italian National Health Service, which include demographic data as well as disease-associated codes registered to manage costs and reimbursement.…”

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

“…Multiple repetitions of AFP, CA125, CA15.3, CA19.9 and CEA were found to be prevalent in patients with cancer or benign diseases, in which the request of tumour markers may be appropriate, while PSA repetitions occur mainly in patients without cancer. The study by Gion et al shows that the mining of EHRs is an effective strategy to assess appropriateness of tumour marker ordering and to optimize performance indicators (20).…”

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

“…For instance, CA15.3 and CEA, although overordered (as shown by the analysis of epidemiological data) (17), are mainly requested in patients with cancer (20), thus suggesting that interventions to enhance appropriateness should be addressed to oncologists. On the other side, overordering of AFP, CA125, CA19.9, and mainly of PSA, occurs in patients without cancer.…”

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

“…In this latter case actions to improve appropriateness should be focused on general practice. Interestingly, in 69.3% of patients labelled with disease codes for "cirrhosis of liver and biliary" or "chronic hepatitis (active)" AFP was not requested (20), although being recommended by some CPGs (21). These findings show that both overordering and underordering may be investigated by exploring EHRs which integrate data captured for administrative purposes and structured information on every health care intervention.…”

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

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Appropriateness of tumor marker request: a case of study

Gion¹,

Trevisiol²,

Fabricio³

2017

Ann. Transl. Med.

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Appropriateness is crucial to provide efficient and high-quality health services at affordable costs. Laboratory medicine is a sector of special interest for the investigation of inappropriateness, due to the high rate of technological innovation and its pivotal role in many diseases and clinical settings. Some subjective aspects related to either the patient or physician seem to have a major role on inappropriateness rates. Given the psychological impact of cancer on both patients and physicians, tumor markers represent a case of study for appropriateness. The assessment of inappropriateness of laboratory tests has been focused mainly on ordering patterns. Appropriateness can barely be appraised by matching the requested test with the clinical problem because clinical information on the test requisition form is usually inadequate. With this novel approach, we showed that inappropriateness is multifaceted even within the specific category of tumour markers. The model was effective in identifying both over-and underordering. Implementation of evidence based information and monitoring their impact on the clinical practice are parts of the same, multistage, process aimed at the progressive improvement of health care.

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Section: Discussionmentioning

confidence: 89%

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

Section: Developing Indicators To Monitor Appropriateness Of Tumor Mamentioning

confidence: 99%

See 3 more Smart Citations

Appropriateness of tumor marker request: a case of study

Gion¹,

Trevisiol²,

Fabricio³

2017

Ann. Transl. Med.

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Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records

et al. 2023

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Purpose The overuse of laboratory tests contributes to impair health systems effectiveness, tumor markers (TMs) being a paradigmatic example. In the present study we applied indicators of TMs appropriateness developed from administrative datasets to appraise regionwide overordering in the clinical practice. Patients and methods TMs ordered to outpatients in the Veneto Region over 6 years were obtained from the eletronic Outpatients’ Records of Diagnostic and Therapeutic Procedures. TMs orders were examined as aggregated data or stratified according to disease codes, gender, age, and requests per patient. TMs recommended only for specific malignancies were examined using epidemiological data obtained from Veneto Tumor Registry. Results A total of 5,821,251 TMs were ordered in 4,382,159 patients over 6 years. Overall, 3,252,389 (55.9%) TMs were ordered without appropriate disease codes (ranging from 77.0% for PSA to 17.5% for CA15.3). TM orders declined over 6 years (−13.4%), with a noticeable reduction of orders without appropriate disease codes (−21.3%). Orders decreased sharply from 2015 to 2016, after the enactment of a national Decree-Law aimed at improving appropriateness, and remained stable thereafter. However, the rate of inappropriate TMs requests still remained elevated (44.4%) in the last year of observation, with orders of TMs being much higher than expected on the basis of prevalence and incidence figures of specific malignancies. Conclusions Indicators developed from administrative datasets were effective in assessing the overordering of TMs and the impact of interventions to improve appropriateness. The developed indicators could be considered for other diagnostic tests.

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The Serum Levels of Tumor Markers in the Elderly Population of Yakutia

Николаев¹,

Efremova²,

Sofronova³

et al. 2019

IJBM

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The purpose of our research was to assess the level of tumor markers in the blood serum of elderly residents of Yakutia. Material and Methods: We examined 204 elderly residents of Yakutia (52 men aged from 60 to 74 years and 152 women aged from 55 to 74 years). The study did not include the people who have oncological or preoncological diseases, or those with exacerbation of chronic diseases. Regarding ethnic origin, all examined people were Yakuts (indigenous people of Yakutia). The levels of tumor markers (AFP, CA 125, and PSA) in the blood serum were determined by ELISA. Results: Among elderly people, the serum level of AFP was at higher levels within within the reference range in single working people and people having a low level of education and/or obesity. The serum level of CA125 in women increased depending on ML, discomfort of housing, and low level of material well-being. The serum level of PSA was at higher levels within the reference range in male smokers.

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Indicators of inappropriate tumour marker use through the mining of electronic health records

Abstract: The developed indicators resulted suitable to monitor TM overordering in outpatients through the mining of EHRs. The present study is a first approach towards the use of big-data mining for TM appropriateness evaluation purposes.

Cited by 8 publications

References 22 publications

Appropriateness of tumor marker request: a case of study

Appropriateness of tumor marker request: a case of study

Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records

The Serum Levels of Tumor Markers in the Elderly Population of Yakutia

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