Value-Based Intervention with Hospital and Pathology Laboratory Informatics: A Case of Analytics and Outreach at the Veterans Affairs
| Autor: | Thomas F. Osborne, Dean Fong, Gregory D. Scott, Sang P Gross |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Informatics
utilization Psychological intervention Health Informatics lcsh:Computer applications to medicine. Medical informatics 030218 nuclear medicine & medical imaging Pathology and Forensic Medicine 03 medical and health sciences value 0302 clinical medicine Intervention (counseling) lcsh:Pathology medicine veterans affairs Veterans Affairs business.industry Brief Report medicine.disease Computer Science Applications Test (assessment) Outreach Analytics 030220 oncology & carcinogenesis General partnership lcsh:R858-859.7 Medical emergency business lcsh:RB1-214 |
| Zdroj: | Journal of Pathology Informatics Journal of Pathology Informatics, Vol 11, Iss 1, Pp 8-8 (2020) |
| ISSN: | 2153-3539 |
| Popis: | Background: Laboratory tests are among the most ordered tests and account for a large portion of wasted health-care spending. Meta-analyses suggest that the most promising interventions at improving health-care value and reducing cost are low investment strategies involving simple changes to ordering systems. The veterans affairs (VA) has a 2018–2024 strategic objective to reduce wasted spending through data- and performance-focused decision-making. Methods: VA Palo Alto Healthcare System laboratory utilization data were obtained from multiple sources, including the VA Corporate Data Warehouse and utilization reports from reference laboratory. Ordering volume, test results, and follow-up clinical impact data were collected and evaluated in partnership with the treating physicians and hospital informatics in order to optimize ordering sets. Results: Dextromethorphan (Dext) and synthetic cannabinoid testing were identified as the lowest value tests based on a three-tier score of negativity rate, volume, and cost. In partnership with the ordering physicians and hospital informatics, reflexive testing was eliminated, resulting in persistent decreases in the volume of Dext (162–10 tests/month) and synthetic cannabinoid tests (155–19 tests/month) ordered. The proportion of unnecessary repeat tests also dropped from 71.5% to 5.5%, the test positivity rate increased from 0.87% to 3.49%, and the approximate monthly cost of both tests decreased ten-fold from $21,250 to $2087 for a yearly savings of $229,000 at a single VA. Conclusions: Improved laboratory utilization is central to the VA' strategic objective to reduce waste. A relatively simple intervention involving partnership with the treating physicians and hospital informatics in combination with data- and performance-focused decision-making can yield substantial reductions in health-care waste. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|