Lab Test Utilization, 03-03-2016
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Transcript of Lab Test Utilization, 03-03-2016
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Ola H. ElgaddarMD, PhD, MBA, CPHQ, LSSGBLecturer of Chemical Pathology
Medical Research InstituteAlexandria University
Laboratory Test Utilization
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What about???
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They order all the lab tests in the world!!
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But here, You can’t “just” order evrything!!!
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Laboratory Test utilizationA strategy for performing appropriatelaboratory and pathology testing with thegoal of providing high-quality, cost-effectivepatient care.
Are you financially or medically driven??
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If the focus is solely on money, then that testutilization effort will have a short termsuccess.However if good medical practice is thefocus, then test utilization will have longevityand will likely be successful in our changinghealth care environment.
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The Good, The Bad & The Ugly• A ‘Good’ test:
– Uses resources but provides information that is useful in patient management decisions
• A ‘Bad’ test:– Uses resources but fails to provide
information useful in patient management decisions
• The ‘Ugly’ test: – Uses resources and provides
information that is misleading or irrelevant
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Considerations while addressing the utilization issue:
ØYou can’t provide every test as fast as what everybody wants!
ØOrdering test panels rather than ala carte’!!Ex: Liver functions, Kidney functions, Lipid profile,…..
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Considerations while addressing the utilization issue:
ØRedundant tests:Urea & CreatinineALT & ASTTroponin & CK-MB
ØTests that are often ”said” together:PT & PTTCalcium, Phosphorus & Magnesium
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Considerations while addressing the utilization issue:
ØPre-analytical concerns that might cause test repetition:Timing, container, labeling, transportation
Ø Appropriateness of the ordered test:Diagnostic performanceAffected by the patient’s conditionEx: Thyroid F. in an ICU patient
HbA1c in hemolytic anemia
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Pre – test probability
An estimate of the probability of a disease before any test is ordered
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How can it affect test ordering / utilization??
• Troponin ordered for a 15 years old boy complaining of heartburn!
Most probably, this is a wrong testselection due to the very low pre-testprobability that this boy is having acardiac event
So, Clinicians must be aware of thepre-test probability before orderingany test
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Considerations while addressing the utilization issue:
ØImpact of the result on management: ex: Haptoglobin, Mumps Abs
Ø How fast do lab results change:Understanding how rapidly a given analyte may change is important to selecting how often it should be ordered
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Considerations while addressing the utilization issue:
ØAcknowledge the gap between what clinicians know, and the depth of knowledge necessary to order lab tests.
Ø Patients’ pressure!
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Test Utilization Management Tools
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1. Meet the clinicians”Education” is the first tool, but if it was the only method being used then it will have a little lasting impact!
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2. Laboratories as gate keepersØDetermine the needed testsØSome tests should be obsolete (ex: BT)ØCheck on frequently ordered tests,
especially for in-patients attended by morethan one physician
ØProvide individualized report cards to thephysicians, in a blame free environment,showing their individual ordering pattern
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3. IT support systemØEntry pop-ups for repeated tests or for
recently ordered tests with normal results
ØOnline decision support tools
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4. Laboratory guidelines and algorithmsØIT-driven:
When clinical data is entered, appropriatelab tests will be suggested
ØLab-driven:Clinicians order initial tests, and accordingto the result, lab doctors initiate a cascadeof further tests
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4. Laboratory guidelines and algorithmsØPathologists-driven:
- For some low volume, high cost tests.- Ordered only by a pathologist or a geneticconsultant, after the reviewing the results ofall previously ordered tests
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5. The Test Menu as Formulary- Several world class centers had set labformularies, just like pharmacy formulary.- No off-formulary test can be available- Test menu is divided into 3 “tires”, each one
is ordered on a certain clinician level.
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We have always been proud of providinghigh-quality, cost-effective care with afocus of providing service to the patientand clinician
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Our new laboratory paradigm demandsthat the clinical laboratory also provide:Utilization Management,Clinical Effectiveness, andData Integrationas part of their expected performance
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Establishment and Implementation of anImprovement Plan using the Lean SixSigma Methodology to Minimize Variation inthe Ordered Lab Requests in the ChemicalPathology Department of the MedicalResearch Institute
Current project
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OLA