Analysis of current thyroid function test ordering practices

Autor: Joshua M. Tate, Mark W. True, Irene Folaron, Joseph Kluesner, Alexis Beauvais, Maria Kravchenko, Jeffrey A. Colburn, Darrick Beckman, Sky D. Graybill, Jana L. Wardian
Rok vydání: 2017
Předmět:
Adult
Male
endocrine system
medicine.medical_specialty
Pediatrics
Adolescent
endocrine system diseases
Thyrotropin
030209 endocrinology & metabolism
Medical Overuse
Thyroid Function Tests
Thyroid function tests
Young Adult
03 medical and health sciences
0302 clinical medicine
Thyroid-stimulating hormone
Reference Values
Internal medicine
medicine
Electronic Health Records
Humans
030212 general & internal medicine
Aged
Retrospective Studies
Aged
80 and over
Hematologic Tests
Triiodothyronine
medicine.diagnostic_test
business.industry
Health Policy
Thyroid disease
Thyroid
Public Health
Environmental and Occupational Health
Middle Aged
medicine.disease
United States
Thyroxine
medicine.anatomical_structure
Endocrinology
Practice Guidelines as Topic
Military health
Female
Thyroid function
business
hormones
hormone substitutes
and hormone antagonists
Hormone
Zdroj: Journal of Evaluation in Clinical Practice. 24:347-352
ISSN: 1365-2753
1356-1294
DOI: 10.1111/jep.12846
Popis: Rationale Current guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease. Objective To evaluate our institution's practice in ordering thyroid function tests (TFTs) and to identify strategies to reduce inappropriate FT4 and FT3 testing. Methods A record of all TFTs obtained in the San Antonio Military Health System during a 3-month period was extracted from the electronic medical record. The TFTs of interest were TSH, FT4, thyroid panel (TSH + FT4), FT3, total thyroxine (T4), and total triiodothyronine (T3). These were categorized based on the presence or absence of hypothyroidism. Results Between August 1 and October 31, 2016, there were 38 214 individual TFTs ordered via 28 597 total laboratory requests; 11 486 of these requests were in patients with a history of hypothyroidism. The number (percent) of laboratory requests fell into these patterns: TSH alone 14 919 (52.14%), TSH + FT4 7641 (26.72%), FT3 alone 3039 (10.63%), FT4 alone 1219 (4.26%), TSH + FT4 + FT3 783 (2.74%), and others 996 (3.48%); 36.0% of TFTs ordered were free thyroid hormones. Projected out to a year, using Department of Defense laboratory costs, $317 429 worth of TFTs would be ordered, with free thyroid hormone testing accounting for $107 720. Conclusion Inappropriate ordering of free thyroid hormone tests is common. In an era of rising healthcare costs, inappropriate thyroid function testing is an ideal target for efforts to reduce laboratory overutilization, which in our system, could save up to $120 000 per year. Further evaluation is needed to determine strategies that can reduce excessive thyroid hormone testing.
Databáze: OpenAIRE
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