Method of Preventing Unnecessary Tests in a Clinical Laboratory

Öz

Background: In countries where health services are free, laboratory test costs are increasing. New software methods for preventing unnecessary tests without obstructing the test orders can provi-de significant savings. The aim of this study was to detect unnecessary test amounts that were prevented for 2 years with algorithms defined in intelligent laboratory software.
Materials and Methods: AlinIQ (Abbott, USA) software has been defined algorithms that detect and cancel unnecessary tests without preventing clinicians from ordering. The prevented quanti-ties of five different laboratory tests (direct bilirubin, chlorine, AST, fPSA and fT3), which were requested from January 2018 to January 2020, were calculated. It was compared with the proporti-onal amounts of the same tests that were performed between January 2016 and January 2018, which were studied without software.
Results: Algorithms prevented 261540 AST, 174096 direct bilirubin, 135373 chlorine, 27486 FT3, 1160 free PSA. A total of 599656 tests were saved in 2 years.
Conclusions: In this study, defined algorithms successfully prevented unnecessary tests. Any clinical laboratory can use these simple algorithms and adapt it for other tests. Millions of dollars can be saved by using intelligent laboratory software in clinical laboratories.

Keywords:

Anahtar Kelimeler

• Test preventing
• AlinIQ
• Algorithm
• Unnecessary test
• Test preventing, AlinIQ, Algorithm, Unnecessary test

Klinik Laboratuvarda Gereksiz Testleri Önleme Yöntemi

Öz

Amaç: Sağlık hizmetlerinin ücretsiz olduğu ülkelerde laboratuvar test maliyetleri artmaktadır. Test sıralarını engellemeden gereksiz testleri önlemek için yeni yazılım yöntemleri önemli tasarruflar sağlayabilir. Bu çalışmanın amacı, akıllı laboratuvar yazılımlarında tanımlanan algoritmalar ile 2 yıl boyunca engellenen gereksiz test miktarlarının tespit edilmesidir. Materyal ve Metod: Algin IQ (Abbott, USA) yazılımı, klinisyenlerin sipariş vermesini engellemeden gereksiz testleri tespit eden ve iptal eden algoritmalar tanımlamıştır. Ocak 2018'den Ocak 2020'ye kadar istenen beş farklı laboratuvar testinin (direkt bilirubin, klor, AST, serbest PSA ve serbest T3) engellenen miktarları hesaplandı. Ocak 2016 ile Ocak 2018 arasında çalışılan aynı testlerin yazılımsız çalışılan oransal miktarları ile karşılaştırılmıştır. Bulgular: Algoritmalar 261540 AST, 174096 direkt bilirubin, 135373 klor, 27486 serbest T3, 1160 serbest PSA'yı engelledi. 2 yılda toplam 599656 test daha az tüketildi. Sonuç: Bu çalışmada tanımlanan algoritmalar, gereksiz testleri başarıyla engellemiştir. Herhangi bir klinik laboratuvar bu basit algoritmaları kullanabilir ve diğer testler için uyarlayabilir. Klinik laboratuvarlarda akıllı laboratuvar yazılımları kullanılarak milyonlarca dolar tasarruf edilebilir.

Anahtar Kelimeler

• Test önleme
• ALIN IQ
• algoritma
• gereksiz test

Kaynakça

1. 1. Keehan SP, Stone DA, Poisal JA, Cuckler GA, Sisko AM, Smith SD, et al. National Health Expenditure Projections, 2016-25: Price Increases, Aging Push Sector To 20 Percent Of Economy. Health Aff. 2017; 36(3): 553-63.
2. 2. Weinberger SE. Providing high-value, cost-conscious care: a critical seventh general competency for physicians. Ann Int Med. 2011; 155(6): 386-8.
3. 3. Bareford D, Hayling A. Inappropriate use of laboratory services: long term combined approach to modify request patterns. BMJ. 1990; 301(6764): 1305-7.
4. 4. Billi JE, Hejna GF, Wolf FM, Shapiro LR, Stross JK. The effects of a cost-education program on hospital charges. JGIM. 1987; 2(5): 306-11.
5. 5. Verstappen WH, van der Weijden T, Sijbrandij J, Smeele I, Hermsen J, Grimshaw J, et al. Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial. JAMA. 2003; 289(18): 2407-12.
6. 6. Verstappen WH, van Merode F, Grimshaw J, Dubois WI, Grol RP, van der Weijden T. Comparing cost effects of two quality strategies to improve test ordering in primary care: a randomized trial. International journal for quality in health care : J Int Soc Qual Health C. 2004; 16(5): 391-8.
7. 7. Solomon DH, Hashimoto H, Daltroy L, Liang MH. Techniques to improve physicians' use of diagnostic tests: a new conceptual framework. JAMA. 1998; 280(23): 2020-7.
8. 8. Wertman BG, Sostrin SV, Pavlova Z, Lundberg GD. Why do physicians order laboratory tests?: A study of laboratory test request and use patterns. JAMA. 1980; 243(20): 2080-2.

9. 9. Gönel A. Clinical biochemistry test eliminator providing cost-effectiveness with five algorithms. J Acta Clin Bel. 2018.
10. 10. Van Walraven C, Naylor CD. Do we know what inappropriate laboratory utilization is?: A systematic review of laboratory clinical audits. JAMA. 1998; 280(6): 550-8.
11. 11. Axt-Adam P, Van Der Wouden JC, Van der Does E. Influencing behavior of physicians ordering laboratory tests: a literature study. Med Care. 1993; 784-94.
12. 12. Hindmarsh JT, Lyon AW. Strategies to promote rational clinical chemistry test utilization. Clin Bioch. 1996; 29(4): 291-9.
13. 13. Wu AH. Improving the utilization of clinical laboratory tests. Int J Clin Pract Suppl. 1998; 4(3): 171-81.
14. 14. Vardy DA, Simon T, Limoni Y, Kuperman O, Rabzon I, Cohen A, et al. The impact of structured laboratory routines in computerized medical records in a primary care service setting. J Med Sys. 2005; 29(6): 619-26.
15. 15. Values C. Message from the Chair of the Council of Laboratory Professionals: Crusade to Order the Right Tests. Crit Val. 2012; 5(2): 10-3.
16. 16. Dowling PT, Alfonsi G, Brown MI, Culpepper L. An education program to reduce unnecessary laboratory tests by residents. Academic medicine : J Ass Am Med Coll. 1989; 64(7): 410-2.
17. 17. Astion M. Overutilization of the laboratory: Part1 Googling our way into overutilization and misinterpretation. Lab Err Patient Saf. 2005; 2(3): 5-6.
18. 18. Daniels M, Schroeder SA. Variation among physicians in use of laboratory tests II. Relation to clinical productivity and outcomes of care. Med Care. 1977; 482-7.
19. 19. Pageler NM, Franzon D, Longhurst CA, Wood M, Shin AY, Adams ES, et al. Embedding time-limited laboratory orders within computerized provider order entry reduces laboratory utilization. Ped Crit Care Med. 2013; 14(4): 413-9.
20. 20. Marton KI, Tul V, Sox HC. Modifying test-ordering behavior in the outpatient medical clinic: a controlled trial of two educational interventions. Arch Int Med. 1985; 145(5): 816-21.
21. 21. Neilson EG, Johnson KB, Rosenbloom ST, Dupont WD, Talbert D, Giuse DA, et al. The impact of peer management on test-ordering behavior. Ann Int Med. 2004; 141(3): 196-204.
22. 22. Yumiba S, Komori K, Iwanishi T, Koida Y, Kobayashi M, Ono Y. A Case of Fulminant Hepatitis after Administration of Abiraterone Acetate. Acta Urol Jap. 2017; 63(11): 479-82.
23. 23. Mitchell E, Ranganathan S, McKiernan P, Squires RH, Strauss K, Soltys K, et al. Hepatic Parenchymal Injury in Crigler-Najjar Type I. J Pediatr Gastroenterol Nutr. 2018; 66(4): 588-594.
24. 24. Yanagisawa Y, Isobe K, Naito A, Ishijima M, Nanmoku T, Yamamoto T, et al. Influence of In Vitro Hemolysis on 80 Different Laboratory Tests. Clin Lab. 2017; 63(2): 219-26.
25. 25. Koseoglu M, Hur A, Atay A, Cuhadar S. Effects of hemolysis interferences on routine biochemistry parameters. Bioch Med. 2011; 21(1): 79-85.
26. 26. King PD. Abnormal liver enzyme levels. Evaluation in asymptomatic patients. Postgrad Med. 1991; 89(4): 137-41.
27. 27. Jang BK. Elevated serum bilirubin levels are inversely associated with nonalcoholic fatty liver disease. Clin Mol Hepa. 2012; 18(4): 357-9.
28. 28. Pfortmueller CA, Uehlinger D, von Haehling S, Schefold JC. Serum chloride levels in critical illness the hidden story. Int Care Med Exp. 2018; 6(1): 10.
29. 29. Dimmen M, Vlatkovic L, Hole KH, Nesland JM, Brennhovd B, Axcrona K. Transperineal prostate biopsy detects significant cancer in patients with elevated prostate-specific antigen levels and previous negative transrectal biopsies. BJU Int. 2012; 110: E69-75.