Vijay Kandalam1, Cheryl K Lau2, Maggie Guo2, Irene Ma1, Christopher Naugler3. 1. Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Alberta Public Laboratories (formerly Calgary Laboratory Services), Calgary, Alberta, Canada. 3. Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Public Laboratories (formerly Calgary Laboratory Services), Calgary, Alberta, Canada. Electronic address: ctnaugle@ucalgary.ca.
Abstract
INTRODUCTION: The avoidance of repeat chemistry testing such as Complete Blood Count (CBC) and Electrolyte Panel (EP) on clinically stable patients was identified as important utilization goals by Choosing Wisely Canada. The purpose of this study was to assess the volume of overutilization of CBC and EP in an inpatient setting in Alberta, Canada, and provide an estimated cost assessment of unnecessary testing. METHODS: The total laboratory testing volumes of two common test panels were collected retrospectively for one-year from January to December 2018. Data was collected on test panels performed in an emergency room (ER) and inpatient setting from three separate Laboratory Information Systems covering the provincial population in Alberta, Canada. Total initial test panel instances, total repeated panels, repeated panels that were previously normal or abnormal, and estimated costs were examined. Cost assessment was completed based on Reference Median Cost (RMC) analysis for each of these two common test panels. RESULTS: During the study period, 2,020,467 (CBC) and 1,455,983 (EP) initial test panel instances were recorded, of which 67.7% and 73.5% were repeated for the CBC and EP, respectively. There was a higher proportion of EP repeated inappropriately (previously normal; 35.6%) compared to CBCs (5.4%). The cost to the province for inappropriately repeating CBC and EP were estimated to be RMC $0.52 million and RMC $1.90 million CAD, respectively. CONCLUSION: Results from this study can assist policy makers in implementing utilization management initiatives and update clinical practice guidelines to reduce costs to healthcare without compromising patient care.
INTRODUCTION: The avoidance of repeat chemistry testing such as Complete Blood Count (CBC) and Electrolyte Panel (EP) on clinically stable patients was identified as important utilization goals by Choosing Wisely Canada. The purpose of this study was to assess the volume of overutilization of CBC and EP in an inpatient setting in Alberta, Canada, and provide an estimated cost assessment of unnecessary testing. METHODS: The total laboratory testing volumes of two common test panels were collected retrospectively for one-year from January to December 2018. Data was collected on test panels performed in an emergency room (ER) and inpatient setting from three separate Laboratory Information Systems covering the provincial population in Alberta, Canada. Total initial test panel instances, total repeated panels, repeated panels that were previously normal or abnormal, and estimated costs were examined. Cost assessment was completed based on Reference Median Cost (RMC) analysis for each of these two common test panels. RESULTS: During the study period, 2,020,467 (CBC) and 1,455,983 (EP) initial test panel instances were recorded, of which 67.7% and 73.5% were repeated for the CBC and EP, respectively. There was a higher proportion of EP repeated inappropriately (previously normal; 35.6%) compared to CBCs (5.4%). The cost to the province for inappropriately repeating CBC and EP were estimated to be RMC $0.52 million and RMC $1.90 million CAD, respectively. CONCLUSION: Results from this study can assist policy makers in implementing utilization management initiatives and update clinical practice guidelines to reduce costs to healthcare without compromising patient care.
Authors: Andrea Christine Shysh; Zahinoor Ismail; Davinder Sidhu; Maggie Guo; Leonard T Nguyen; Christopher Naugler Journal: Drugs Real World Outcomes Date: 2021-05-23
Authors: Janet E Squires; Danielle Cho-Young; Laura D Aloisio; Robert Bell; Stephen Bornstein; Susan E Brien; Simon Decary; Melissa Demery Varin; Mark Dobrow; Carole A Estabrooks; Ian D Graham; Megan Greenough; Doris Grinspun; Michael Hillmer; Tanya Horsley; Jiale Hu; Alan Katz; Christina Krause; John Lavis; Wendy Levinson; Adrian Levy; Michelina Mancuso; Steve Morgan; Letitia Nadalin-Penno; Andrew Neuner; Tamara Rader; Wilmer J Santos; Gary Teare; Joshua Tepper; Amanda Vandyk; Michael Wilson; Jeremy M Grimshaw Journal: CMAJ Date: 2022-02-28 Impact factor: 16.859