Reducing the use of coagulation test panels

Amukele, Timothy; Baird, Geoffrey S.; Chandler, Wayne L.

doi:10.1097/mbc.0b013e32834b8246

Cited by 13 publications

(9 citation statements)

References 22 publications

(24 reference statements)

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“…1). A prior study indicated that most mixing study results in acute care adult patients fell into one of the three patterns: for prolonged PT only, VKD factor deficiency was most likely and that curve was used; for prolonged PT and aPTT, again VKD factor deficiency was most likely and that curve was used; and for prolonged aPTT only, single-factor deficiency was most likely and the average single-factor deficiency curve used [4]. If clinical history suggested otherwise a different curve could be selected.…”

Section: Discussionmentioning

confidence: 97%

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Evaluation of prothrombin time and activated partial thromboplastin time mixing studies using an estimated factor correction method

Chen

Phillips

Chandler

2016

Blood Coagulation &Amp; Fibrinolysis

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Mixing studies for prolonged prothrombin time (PT)/activated partial thromboplastin time (aPTT) are used to estimate whether the prolongation is due to an inhibitor or factor deficiency. We propose a new method of mixing study interpretation based on estimation of average factor level changes. Factor level vs. PT/aPTT curves were prepared for single factor, vitamin K-dependent factor, and all factor deficiencies. These curves were used to predict the factor level in the sample and the correction needed to differentiate deficiencies from inhibitors. We compared this estimated factor correction (EFC) method to normal range, percentage correction, and Rosner index. For a given factor level, multiple factor deficiencies prolonged the PT/aPTT more than single factor deficiency, necessitating different thresholds for defining correction on mixing studies. The EFC method was superior to other the correction methods, correctly identifying 38 of 39 known inhibitors, single and multiple factor deficiencies, and correctly identifying inhibitor vs. deficiency in 50 of 59 patient samples. In 99 adult patient mixing studies over 18 months, 30% showed deficiency only, 30% inhibitor only, whereas 40% showed evidence of both. The EFC method for PT/aPTT mixing study interpretation was more accurate than the comparison methods at determining deficiency versus inhibitor.

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Section: Discussionmentioning

confidence: 97%

“…On the basis of a prior study of hospitalized patients [4], we assumed results fell into one of the three patterns ( Fig. 1): normal PT with prolonged aPTT, prolonged PT with normal aPTT, or prolonged PT and aPTT.…”

Section: Interpretation Of Mixing Studiesmentioning

confidence: 99%

Evaluation of prothrombin time and activated partial thromboplastin time mixing studies using an estimated factor correction method

Chen

Phillips

Chandler

2016

Blood Coagulation &Amp; Fibrinolysis

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“…As an acute-phase reactant, fibrinogen, as well as CRP, provide added information that may lead to moreaggressive treatment to prevent cardiovascular diseases. 3 The reimbursement volume for this test increased 3.8-fold from 2000 through 2010.…”

Section: Tests Used For Triage and Risk Assessment Of Cardiovascular mentioning

confidence: 99%

“…3 Increasingly, the fibrinogen test is used with other cardiac risk markers to determine overall risk for cardiovascular disease. As an acute-phase reactant, fibrinogen, as well as CRP, provide added information that may lead to moreaggressive treatment to prevent cardiovascular diseases.…”

Section: Tests Used For Triage and Risk Assessment Of Cardiovascular mentioning

confidence: 99%

“…During the study period, many publications provided guidance on the use of specific analytes, which may have affected their use. Many of the selected analytes, some included in one or more test panels, showed significant trends in their reimbursement volumes, and those specifically discussed in this report include fibrinogen 3 ; high-sensitivity C-reactive protein (hs-CRP) [4][5][6] ; brain natriuretic peptide (BNP) [7][8][9] ; cardiac troponins [7][8][9][10][11][12][13] ; thyroid-stimulating hormone (TSH) [14][15][16][17] ; testosterone 18,19 ; human papillomavirus (HPV) DNA [20][21][22] ; carbohydrate antigen (CA) 19-9 [23][24][25][26][27] ; vitamin D [28][29][30] ; hepatitis B virus (HBV) surface antigen 31,32 ; hepatitis C virus (HCV) antibody [33][34][35] ; Borrelia burgdorferi…”

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confidence: 99%

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Trends in Laboratory Test Volumes for Medicare Part B Reimbursements, 2000–2010

Shahangian

Alspach

Astles

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Changes in reimbursements for clinical laboratory testing may help us assess the effect of various variables, such as testing recommendations, market forces, changes in testing technology, and changes in clinical or laboratory practices, and provide information that can influence health care and public health policy decisions. To date, however, there has been no report, to our knowledge, of longitudinal trends in national laboratory test use. Objective.—To evaluate Medicare Part B–reimbursed volumes of selected laboratory tests per 10 000 enrollees from 2000 through 2010. Design.—Laboratory test reimbursement volumes per 10 000 enrollees in Medicare Part B were obtained from the Centers for Medicare & Medicaid Services (Baltimore, Maryland). The ratio of the most recent (2010) reimbursed test volume per 10 000 Medicare enrollees, divided by the oldest data (usually 2000) during this decade, called the volume ratio, was used to measure trends in test reimbursement. Laboratory tests with a reimbursement claim frequency of at least 10 per 10 000 Medicare enrollees in 2010 were selected, provided there was more than a 50% change in test reimbursement volume during the 2000–2010 decade. We combined the reimbursed test volumes for the few tests that were listed under more than one code in the Current Procedural Terminology (American Medical Association, Chicago, Illinois). A 2-sided Poisson regression, adjusted for potential overdispersion, was used to determine P values for the trend; trends were considered significant at P < .05. Results.—Tests with the greatest decrease in reimbursement volumes were electrolytes, digoxin, carbamazepine, phenytoin, and lithium, with volume ratios ranging from 0.27 to 0.64 (P < .001). Tests with the greatest increase in reimbursement volumes were meprobamate, opiates, methadone, phencyclidine, amphetamines, cocaine, and vitamin D, with volume ratios ranging from 83 to 1510 (P < .001). Conclusions.—Although reimbursement volumes increased for most of the selected tests, other tests exhibited statistically significant downward trends in annual reimbursement volumes. The observed changes in reimbursement volumes may be explained by disease prevalence and severity, patterns of drug use, clinical or laboratory practices, and testing recommendations and guidelines, among others. These data may be useful to policy makers, health systems researchers, laboratory directors, and industry scientists to understand, address, and anticipate trends in laboratory testing in the Medicare population.

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