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Kuti MA, Bamidele OT, Udeh CT, Eseile BJ, Ogundeji OA. Appropriate use of plasma glucose tests for diagnosis of diabetes mellitus in Ibadan, Nigeria. Afr J Lab Med 2022; 11:1433. [PMID: 35547334 PMCID: PMC9082232 DOI: 10.4102/ajlm.v11i1.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Diabetes mellitus is a growing epidemic in Africa. Its diagnosis relies exclusively on laboratory evidence, which differs based on clinical circumstances.Objective: The study described the appropriateness of plasma glucose test requests per the American Diabetes Association criteria.Methods: We reviewed the plasma glucose test requests received by the chemical pathology laboratory of the University College Hospital, Ibadan, Nigeria between June 2018 and November 2018. The American Diabetes Association diabetes diagnostic criteria were used to define the appropriateness of test requests and determine the potential for ill-informed clinical decisions.Results: Four hundred and twenty-three requisition forms were included, with the majority from the medical wards/clinics (72.3%); the most frequent reason for a plasma glucose test was systemic hypertension (28.6%). Fasting plasma glucose was most requested (254; 60.0%). One hundred and sixteen (27.4%) requests were potentially inappropriate, with the 2-h postprandial plasma glucose (2hPPG) test requests (83; 71.6%) being the most inappropriate. The difference in the proportion of inappropriate requests was not statistically significantly between medical or surgical wards/clinics (Odds ratio 1.131, 95% confidence interval 0.709–1.803, p = 0.605). Inappropriate requests in six cases may have triggered inappropriate action.Conclusion: A third of the glucose tests requested for querying diabetes mellitus may have been inappropriate. Results of such testing may trigger inappropriate clinical action. To improve the quality of care and for economic reasons, laboratories should have programmes to improve the appropriate use of their services.
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Affiliation(s)
- Modupe A Kuti
- Department of Chemical Pathology, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
| | - Olabisi T Bamidele
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
| | - Chioma T Udeh
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
| | - Bola J Eseile
- Department of Chemical Pathology, University College Hospital, Ibadan, Nigeria
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Hardy NL, Jacobs J, Mullins K, Christenson R, Cox T, Murphy C, Koka R. Pathology Trainees Gain Clinical Pathology Experience as Lab Consultants Through Auditing Myeloid Mutation Panel Send-Out Tests. Arch Pathol Lab Med 2022; 146:1286-1290. [PMID: 35089993 DOI: 10.5858/arpa.2021-0334-ep] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Inappropriate laboratory testing and the threat it poses to patient care and rising health care costs has become an important focus in the medical literature. Pathology residents, as physicians with an intimate knowledge of laboratory testing, may be uniquely equipped with the tools to intervene in situations of inappropriate testing and also benefit from lab use experience as part of their clinical pathology training. OBJECTIVE.— To employ a resident-driven initiative aimed at incorporating pathology residents as consultants for appropriate ordering of high-volume, send-out myeloid mutation panel testing. DESIGN.— During a 6-month study period, all myeloid mutation panel send-out tests were screened by senior pathology residents on their clinical chemistry rotation prior to approval at an academic medical center. A retrospective review of myeloid mutation panels from the prior 6 months was conducted with the same criteria to determine effectiveness of the intervention. RESULTS.— Of the 234 tests ordered during the study period, screening resulted in cancellation of 17% (n = 39), with proportional cost savings. The number of inappropriate orders successfully cancelled was significant compared with the preintervention period (control, 0%; intervention, 76.5%; P < .001, Fisher exact test). There was no significant difference in the proportion of inappropriate tests before and after intervention. CONCLUSIONS.— Although test ordering patterns did not substantially change during the intervention period, pathology residents effectively reduced inappropriate myeloid mutation panel testing through prospective send-out auditing, leading to significant cost savings. Moreover, assessment of test use and appropriateness provided critical clinical pathology training within the areas of hematology, molecular genetics, and laboratory management.
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Affiliation(s)
- Naomi L Hardy
- From the Department of Pathology (Hardy, Jacobs), University of Maryland Medical Center, Baltimore
| | - Jonathan Jacobs
- From the Department of Pathology (Hardy, Jacobs), University of Maryland Medical Center, Baltimore
| | - Kristin Mullins
- Pathology and Lab Chemistry (Mullins, Christenson), University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert Christenson
- Pathology and Lab Chemistry (Mullins, Christenson), University of Maryland School of Medicine, Baltimore, Maryland
| | - Thoko Cox
- Laboratories of Pathology (Cox), University of Maryland Medical Center, Baltimore
| | - Colin Murphy
- Transfusion Medicine in Laboratories of Pathology (Murphy), University of Maryland School of Medicine, Baltimore, Maryland
| | - Rima Koka
- The Department of Pathology (Koka), University of Maryland School of Medicine, Baltimore, Maryland
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Badrick T, Ge Y, Gou G, Wong W. What factors are associated with improvements in productivity in clinical laboratories in the Asia Pacific Region? Clin Biochem 2021; 99:103-110. [PMID: 34699763 DOI: 10.1016/j.clinbiochem.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Clinical laboratories usually have a quality management system such as ISO 15189, which provides a framework for quality and competence to perform medical testing and internal systems such as audit and nonconformance to ensure consistent processes. However, organizations need to have access to internal procedures and external competitors' performance to improve their operations. These are often seen as commercial or areas where it is difficult to agree on an acceptable goal. METHOD In 2019, 1158 laboratories from 17 countries/regions in the Asia Pacific Region answered the survey, including 399 Chinese sites. The survey collected information on quality, turnaround time and productivity. RESULTS Median productivity for laboratories in the Asia Pacific Region not including Chinese sites was 25 samples/FTE/day for small laboratories (workload: <250 samples/day), 100 for medium-sized laboratories (workload: 251-1000 samples/day) and 220 for large laboratories (workload: >1001 samples/day). The parameters associated with increased productivity in some laboratories were automation, middleware, Lean Six Sigma quality improvement activities and International Accreditation. CONCLUSION This survey provides evidence of an association of quality improvement activities on laboratory productivity. There are differences in the effect of these activities in Chinese and non-Chinese laboratories in the Asia Pacific Region. The survey confirmed that the implementation of automation is associated with increased median productivity in all sites. Implementation of Lean Six Sigma and International Accreditation is associated with increased productivity in large laboratories.
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Affiliation(s)
- Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards, Sydney, Australia.
| | - Yichen Ge
- Roche Diagnostics Asia Pacific Pte Ltd, Singapore
| | - Ging Gou
- Roche Diagnostics Asia Pacific Pte Ltd, Singapore
| | - Wesley Wong
- Roche Diagnostics Asia Pacific Pte Ltd, Singapore
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Lang T. Minimum retesting intervals in practice: 10 years experience. ACTA ACUST UNITED AC 2020; 59:39-50. [DOI: 10.1515/cclm-2020-0660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Minimum retesting intervals (MRI) are a popular demand management solution for the identification and reduction of over-utilized tests. In 2011 Association of Clinical Biochemistry and Laboratory Medicines (ACB) published evidence-based recommendations for the use of MRI.
Aim
The aim of the paper was to review the use of MRI over the period since the introduction of these recommendations in 2011 to 2020 and compare it to previous published data between 2000-2010.
Methods
A multi-source literature search was performed to identify studies that reported the use of a MRI in the management or identification of inappropriate testing between the years prior to (2000–2010) and after implementation (2011–2020) of these recommendations.
Results
31 studies were identified which met the acceptance criteria (2000–2010 n=4, 2011–2020 n=27). Between 2000 and 2010 4.6% of tests (203,104/4,425,311) were identified as failing a defined MRI which rose to 11.8% of tests (2,691,591/22,777,288) in the 2011–2020 period. For those studies between 2011 and 2020 reporting predicted savings (n=20), 14.3% of tests (1,079,972/750,580) were cancelled, representing a total saving of 2.9 M Euros or 2.77 Euro/test. The most popular rejected test was Haemoglobin A1c which accounted for nearly a quarter of the total number of rejected tests. 13 out 27 studies used the ACB recommendations.
Conclusions
MRI are now an established, safe and sustainable demand management tool for the identification and management of inappropriate testing. Evidence based consensus recommendations have supported the adoption of this demand management tool into practice across multiple healthcare settings globally and harmonizing laboratory practice.
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Affiliation(s)
- Tim Lang
- Department of Clinical Biochemistry , University Hospital of North Durham , North Road , Durham , County Durham , DH1 5TW , UK
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Ibarz M, Cadamuro J, Sumarac Z, Guimaraes JT, Kovalevskaya S, Nybo M, Cornes MP, Vermeersch P, Simundic AM, Lippi G. Clinicians' and laboratory medicine specialists' views on laboratory demand management: a survey in nine European countries. ACTA ACUST UNITED AC 2020; 8:111-119. [PMID: 31990661 DOI: 10.1515/dx-2019-0081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/05/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laboratory tests are an essential aspect of current medical practice and their use has grown exponentially. Several studies however have demonstrated inappropriate use of laboratory testing. This inappropriateness can lead to delayed or wrong diagnosis, negatively impacting patient safety and an increase in health care expenditure. The aim of the present small-scale survey was to obtain information on the current status of demand management in European laboratories, as well as the opinions of laboratory and clinical professionals in this regard. METHODS Two surveys were developed, one for laboratory specialists and one for clinicians, covering information on current use, knowledge and opinions on the possible impact of different demand management strategies on patient outcome and health care costs. Additionally, we asked for the current state and willingness on collaboration of laboratory specialists and clinicians. RESULTS One hundred and fifty responses, 72 laboratory specialists and 78 clinicians, from nine countries were received. Developing local ordering protocols/profiles in collaboration with clinicians was the most used strategy (80.3% of laboratories). Of clinicians, 85.6% considered measures to ensure appropriate use of tests necessary and 100% were interested in advice/information about their indication. Of the laboratory specialists 97.2% were either already participating or willing to participate in multidisciplinary groups on the appropriateness of test demand as were 60.3% of clinicians, and 85.9% of clinicians were interested in attending activities about laboratory test demand management. CONCLUSIONS The results of our survey show that tools to improve the appropriate use of laboratory tests are already regularly used today. Laboratory medicine specialists as well as clinicians are willing to undertake additional shared activities aimed at improving patient-centered laboratory diagnostic workup.
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Affiliation(s)
- Mercedes Ibarz
- Department of Clinical Laboratory, University Hospital Arnau de Vilanova, IRBLleida, Rovira Roure 80, 25198 Lleida, Spain
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Zorica Sumarac
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Pharmacy, Novi Sad, Serbia
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, Sao Joao Hospital Center, University of Porto, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.,EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Svetlana Kovalevskaya
- Clinical Laboratory Diagnostic Department with Course of Molecular Medicine, 1st Pavlov State Medical University, St-Petersburg, Russia
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Michael P Cornes
- Department of Clinical Biochemistry, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Pieter Vermeersch
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital "Sveti Duh", Zagreb, Croatia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Meidani Z, Mousavi GA, Kheirkhah D, Benar N, Maleki MR, Sharifi M, Farrokhian A. Going beyond audit and feedback: towards behaviour-based interventions to change physician laboratory test ordering behaviour. J R Coll Physicians Edinb 2019. [PMID: 29537404 DOI: 10.4997/jrcpe.2017.407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Studies indicate there are a variety of contributing factors affecting physician test ordering behaviour. Identifying these behaviours allows development of behaviour-based interventions. Methods Through a pilot study, the list of contributing factors in laboratory tests ordering, and the most ordered tests, were identified, and given to 50 medical students, interns, residents and paediatricians in questionnaire form. The results showed routine tests and peer or supervisor pressure as the most influential factors affecting physician ordering behaviour. An audit and feedback mechanism was selected as an appropriate intervention to improve physician ordering behaviour. The intervention was carried out at two intervals over a three-month period. Findings There was a large reduction in the number of laboratory tests ordered; from 908 before intervention to 389 and 361 after first and second intervention, respectively. There was a significant relationship between audit and feedback and the meaningful reduction of 7 out of 15 laboratory tests including complete blood count (p = 0.002), erythrocyte sedimentation rate (p = 0.01), C-reactive protein (p = 0.01), venous blood gas (p = 0.016), urine analysis (p = 0.005), blood culture (p = 0.045) and stool examination (p = 0.001). Conclusion The audit and feedback intervention, even in short duration, affects physician ordering behaviour. It should be designed in terms of behaviour-based intervention and diagnosis of the contributing factors in physicians' behaviour. Further studies are required to substantiate the effectiveness of such behaviour-based intervention strategies in changing physician behaviour.
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Affiliation(s)
- Z Meidani
- D Kheirkhah, Infectious Diseases Research Centre, Kashan University of Medical Sciences, Kashan, Iran.
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Nguyen LT, Guo M, Hemmelgarn B, Quan H, Clement F, Sajobi T, Thomas R, Turin TC, Naugler C. Evaluating practice variance among family physicians to identify targets for laboratory utilization management. Clin Chim Acta 2019; 497:1-5. [PMID: 31228416 DOI: 10.1016/j.cca.2019.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is widespread variation in testing practice among practitioners, however there has been no objective way to pinpoint target tests for utilization management. We propose to take advantage of inter-physician variance in clinical practice as a quantitative measure to generate lists of potentially misutilized tests. METHODS Testing frequencies from a database of clinical testing volumes for outpatients in Calgary, Canada, were obtained for the study period of 2016. For each chemistry, microbiology or hematology test, an arithmetic coefficient of variation (CV) was calculated from family physicians' ordering frequencies. RESULTS The mean CV for all 358 tests considered was 219% (95% CI 206-231%) with a range of 52-729%. The highest variance was observed for human T-lymphotropic virus antibody testing and several tests for heavy metal levels (mercury, copper, zinc and chromium). Among the 100 most commonly run tests, high variance was found for several endocrinology tests including cortisol. CONCLUSIONS The utility of ranking clinical tests by ordering variance presents a practical approach to evaluate relative variation in physician practice strategy and to identify potential areas of misutilization.
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Affiliation(s)
- Leonard T Nguyen
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maggie Guo
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brenda Hemmelgarn
- Department Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Department Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Fiona Clement
- Department Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tolulope Sajobi
- Department Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Roger Thomas
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Naugler C, Church DL. Clinical laboratory utilization management and improved healthcare performance. Crit Rev Clin Lab Sci 2019. [DOI: 10.1080/10408363.2018.1526164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Naugler
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
- Department of Family Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Deirdre L. Church
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
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Rubinstein M, Hirsch R, Bandyopadhyay K, Madison B, Taylor T, Ranne A, Linville M, Donaldson K, Lacbawan F, Cornish N. Effectiveness of Practices to Support Appropriate Laboratory Test Utilization: A Laboratory Medicine Best Practices Systematic Review and Meta-Analysis. Am J Clin Pathol 2018; 149:197-221. [PMID: 29471324 PMCID: PMC6016712 DOI: 10.1093/ajcp/aqx147] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives To evaluate the effectiveness of practices used to support appropriate clinical laboratory test utilization. Methods This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practices A6 cycle method. Eligible studies assessed one of the following practices for effect on outcomes relating to over- or underutilization: computerized provider order entry (CPOE), clinical decision support systems/tools (CDSS/CDST), education, feedback, test review, reflex testing, laboratory test utilization (LTU) teams, and any combination of these practices. Eligible outcomes included intermediate, systems outcomes (eg, number of tests ordered/performed and cost of tests), as well as patient-related outcomes (eg, length of hospital stay, readmission rates, morbidity, and mortality). Results Eighty-three studies met inclusion criteria. Fifty-one of these studies could be meta-analyzed. Strength of evidence ratings for each practice ranged from high to insufficient. Conclusion Practice recommendations are made for CPOE (specifically, modifications to existing CPOE), reflex testing, and combined practices. No recommendation for or against could be made for CDSS/CDST, education, feedback, test review, and LTU. Findings from this review serve to inform guidance for future studies.
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Affiliation(s)
| | | | | | | | - Thomas Taylor
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Anne Ranne
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Nancy Cornish
- Centers for Disease Control and Prevention, Atlanta, GA
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Lapić I, Juroš GF, Rako I, Rogić D. Changing the electronic request form proves to be an effective tool for optimizing laboratory test utilization in the emergency department. Int J Med Inform 2017; 102:29-34. [DOI: 10.1016/j.ijmedinf.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 02/01/2023]
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Mohammed EA, Naugler C. Open-source Software for Demand Forecasting of Clinical Laboratory Test Volumes Using Time-series Analysis. J Pathol Inform 2017; 8:7. [PMID: 28400996 PMCID: PMC5359993 DOI: 10.4103/jpi.jpi_65_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/27/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Demand forecasting is the area of predictive analytics devoted to predicting future volumes of services or consumables. Fair understanding and estimation of how demand will vary facilitates the optimal utilization of resources. In a medical laboratory, accurate forecasting of future demand, that is, test volumes, can increase efficiency and facilitate long-term laboratory planning. Importantly, in an era of utilization management initiatives, accurately predicted volumes compared to the realized test volumes can form a precise way to evaluate utilization management initiatives. Laboratory test volumes are often highly amenable to forecasting by time-series models; however, the statistical software needed to do this is generally either expensive or highly technical. METHOD In this paper, we describe an open-source web-based software tool for time-series forecasting and explain how to use it as a demand forecasting tool in clinical laboratories to estimate test volumes. RESULTS This tool has three different models, that is, Holt-Winters multiplicative, Holt-Winters additive, and simple linear regression. Moreover, these models are ranked and the best one is highlighted. CONCLUSION This tool will allow anyone with historic test volume data to model future demand.
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Affiliation(s)
- Emad A Mohammed
- Department of Electrical and Computer Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada; Department of Pathology, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada; Department of Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada; Department of Family Medicine, Diagnostic and Scientific Centre, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada; Department of Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada; Department of Family Medicine, Diagnostic and Scientific Centre, University of Calgary and Calgary Laboratory Services, Calgary, AB, Canada
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Pelloso M, Basso D, Padoan A, Fogar P, Plebani M. Computer-based-limited and personalised education management maximise appropriateness of vitamin D, vitamin B12 and folate retesting. J Clin Pathol 2016; 69:777-83. [DOI: 10.1136/jclinpath-2015-203447] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/13/2016] [Indexed: 12/18/2022]
Abstract
AimTo identify the best management strategy for improving the appropriateness of vitamin D, vitamin B12 and folate retesting.MethodsThe study was conducted between 3 November 2012 and 8 June 2015, with inpatients and outpatients being considered separately. After an observational reference period (3 November 2012 to 14 September 2013), an information technology (IT)-based permissive strategy (16 September 2013 to 27 July 2014) followed by a limiting strategy was used to manage the demand for inpatient retesting. For outpatients, an educational strategy period (28 July 2014 to 16 December 2014) with direct contact between medical personnel and general practitioners (GPs) was followed by a post-educational period without any restriction. Data from a total of 66 496 patients for vitamin D, 14 618 for vitamin B12 and 14 445 for folate were retrieved from the laboratory IT system. The main outcomes measures were inappropriate vitamin D, vitamin B12 and folate retesting. The minimal retesting intervals were 90 (vitamin D) or 180 days (vitamin B12 and folate).ResultsIn the absence of a laboratory demand strategy, the frequency of inappropriate retesting for vitamin D, vitamin B12 and folate was 60%, 94% and 93%, respectively, for inpatients, and 27%, 87% and 87%, respectively, for outpatients. A limiting IT-based demand management strategy reduced inappropriate retesting for vitamin D (36%), but not for vitamin B12 and folate. The educational strategy was followed by a reduction in inappropriate retesting among outpatients (16% for vitamin D, 72% for vitamin B12 and folate).ConclusionsLaboratory demand management based on an IT-limiting management strategy or on education of the referring physicians appears helpful in maximising appropriate retesting.
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Plebani M. Harmonization in laboratory medicine: Requests, samples, measurements and reports. Crit Rev Clin Lab Sci 2015; 53:184-96. [DOI: 10.3109/10408363.2015.1116851] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Naugler C, Thomas R, Turin TC, Guo M. Yearly Clinical Laboratory Test Expenditures for Different Medical Specialties in a Major Canadian City. Am J Clin Pathol 2015; 144:97-102. [PMID: 26071467 DOI: 10.1309/ajcp80repiugvxph] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Very little is known about the relative contributions of physician specialty groups and individual physicians to overall clinical laboratory expenditures. The objectives of this study were to determine the costs of clinical laboratory test expenditures attributable to 30 medical specialties and the associated per capita physician expenditures for an entire major Canadian city. Only chemistry, hematology, and microbiology tests were included in this study. METHODS Retrospective cohort study involving all physicians in Calgary, Canada, and surrounding areas (n = 3,499) and secondary data on laboratory test orders. RESULTS Data were obtained on approximately 20 million test requests. The mean clinical laboratory test expenditure, in Canadian dollars, per physician was $27,945 for all physicians combined. Total expenditures by primary care physicians (family physicians and general practitioners) accounted for 58% of total expenditures. CONCLUSIONS There was wide variation in clinical laboratory test expenditures among specialties and on a per capita basis within medical specialties.
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Smit I, Zemlin AE, Erasmus RT. Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town. Ann Clin Biochem 2014; 52:481-7. [DOI: 10.1177/0004563214567688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/15/2022]
Abstract
Background Demand management is an area of laboratory activity, which is becoming increasingly important. Within the health-care system, demand management can be defined as the use of health resources to maximise its utility. Tygerberg Hospital has introduced an electronic gate-keeping system. Chemistry tests which generate the highest cost are subjected to this system and may be automatically rejected according to a set of rules. This study aimed: (1) to identify the number of chemistry tests rejected by the eGK; (2) to identify which of these rejected tests were subsequently restored and (3) to assess the impact of rejections on clinical outcome and cost-saving. Methods A retrospective audit was conducted to determine the number of chemistry tests rejected and subsequently restored over a 6-month period. The case-notes of patients for whom requested tests previously rejected had been restored were randomly selected and investigated to assess clinical impact. Any cost-saving was calculated. Results A total of 68,480 tests were subjected to gate-keeping, and 4605 tests (6.7%) were rejected while 679 (14.7%) of these were restored by the requestor phoning the laboratory after obtaining authorisation. After examining a subset of clinical notes it was found that in most cases (80%), patient care was unaffected. The total cost saved was £25,387. Conclusions The majority of the rejected tests were unnecessary and following rejection, real savings were made. Electronic gate-keeping is a simple, effective and sustainable method of demand management.
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Affiliation(s)
- Ida Smit
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
| | - Annalise E Zemlin
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa
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Hung KY, Jerng JS. Time to have a paradigm shift in health care quality measurement. J Formos Med Assoc 2014; 113:673-9. [DOI: 10.1016/j.jfma.2014.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/14/2014] [Accepted: 06/19/2014] [Indexed: 01/21/2023] Open
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