EFFECTS OF USING CLINICAL DECISION SUPPORT TOOLS ON VITAMIN D COST EFFECTIVENESS

Öz

Background: In medical practices worldwide, vitamin D testing is widely requested. However, the cost-effectiveness of vitamin D testing is a major concern. Many laboratories are turning to the use of clinical decision support systems (CDSS) to reduce unnecessary demand and thus the cost burden on the system. In this study, we investigated the impact of the implementation of CDSS on costs and changes in test demand before and after rationalisation of test demand. Methods: We analysed testing requests 90 days before (8 December 2018 - 8 March 2019) and 90 days after (9 March 2019 - 9 June 2019) the implementation of the CDSS in the hospital's software system. While this system completely blocked test requests from some clinics, with the exception of the intensive care unit and the ward, it allowed diagnostic requests in other clinics 90 days before (8 December 2018 - 8 March 2019) and 90 days after (9 March 2019 - 9 June 2019) implementation of CDSS in the hospital software system. The system generated a screen warning if the patient had had a vitamin D test in the previous 90 days.The Microsoft Excel pivot table tool was used to analyse test orders. The cost of the tests was compared before and after the implementation of the clinical decision support system. Results: There were 31,066 requests for 25(OH) vitamin D in the first period. There were 18,830 requests for the same analyte in the second period. This resulted in an approximately 39 percent reduction in testing requests (12,236 tests) (p<0.0001). Savings of $37,350 in three months, or an estimated annual savings of approximately $150,000. Conclusions: Incorporating CDSS into the hospital's software system resulted in a significant reduction in requests for 25(OH) vitamin D testing. The development and use of new clinical software systems in laboratories is important in terms of both resource and human workforce efficiency.

Anahtar Kelimeler

• Vitamin D testing
• clinical decision support
• costs

Etik Beyan

Ethics committee approval and informed consent form were not obtained for this study since the data is available to researchers and does not contain descriptive patient results

KLİNİK KARAR DESTEK ARAÇLARININ KULLANILMASININ D VİTAMİNİ MALİYET ETKİNLİĞİNE ETKİSİ

Öz

Amaç: D vitamini testleri tıbbi uygulamada tüm dünyada yaygın olarak talep edilmektedir. Birçok laboratuvar, sistem üzerindeki gereksiz talep yükünü ve dolayısıyla maliyet yükünü azaltmak için klinik karar destek sistemlerinin kullanımına yönelmektedir. Bu çalışmada D vitamini test isteği öncesi ve sonrasında uygulanan klinik karar destek sistemlerinin maliyete ve test isteğindeki değişime etkisi incelenmiştir. Gereç ve Yöntem: Klinik karar destek sistemlerinin hastane yazılım sistemine girmesinden önceki (8/12/2018-8/03/2019) ve sonrası (9/03/2019-9/06/2019) 90 gün boyunca test isteklerini analiz ettik. Bu sistem, yoğun bakım ve yatan hastalar dışında bazı kliniklerden gelen test taleplerini tamamen bloke ederken, bazılarında tanı amaçlı taleplere izin veriyor ve hastanın son 90 gün içinde D vitamini testi yaptırmış olması halinde sistemde ekran uyarısı oluşturuyordu. Test siparişlerini analiz etmek için Microsoft Excel'in Pivot Tablo aracı kullanıldı. Klinik karar destek sistemlerinin tanıtılmasından önceki ve sonraki test maliyetleri karşılaştırıldı. Bulgular: İlk dönemde 31.066 25(OH) D vitamini talebi oldu. İkinci dönemde aynı analit için 18.830 talep geldi. Dolayısıyla test isteminde yaklaşık %39'luk (12.236 test) bir azalmaya gerçekleşti (p<0.0001). Bu da, üç ayda 37.350 ABD Doları veya tahmini yıllık yaklaşık 150.000 ABD Doları tasarruf olarak hesaplanmıştır. Sonuç: Hastanenin yazılım sistemine klinik karar destek sistemlerinin eklenmesi, 25(OH) D vitamini testi talebinde ve maliyette önemli bir azalma ile sonuçlanmıştır. Laboratuvarlarda yeni klinik yazılım sistemlerinin geliştirilmesi ve kullanılması hem kaynak hem de insan işgücü verimliliği açısından önemlidir.

Anahtar Kelimeler

• D vitamini testi
• klinik karar destek
• maliyet

Etik Beyan

Etik kurul mevcut değildir. Çalışmamızda materyal metod bölümünde ''Biochemical measurement'' başlığı altında ''Veriler araştırmacıların kullanımına açık olduğundan ve tanımlayıcı hasta sonuçları içermediğinden bu çalışma için etik kurul onayı ve bilgilendirilmiş onam formu alınmamıştır'' olarak belirtilmiştir. Çalışmada sadece d vitamini test sayısı kullanılmış olup sonuç içermemektedir.

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