Ordering Patterns and Costs of Specialized Laboratory Testing by Hospitalists and House Staff in Hospitalized Patients With HIV at a County Hospital: An Opportunity for Diagnostic Stewardship

被引：6

作者：

Bolles, Kathryn ^{[1
]}

Woc-Colburn, Laila ^{[2
]}

Hamill, Richard J. ^{[2
,3
]}

Hemmige, Vagish ^{[4
]}

机构：

[1] Univ Washington, Dept Med, Seattle, WA USA

[2] Baylor Coll Med, Dept Med, Div Infect Dis, Houston, TX 77030 USA

[3] Michael E DeBakey VA Med Ctr, Med Care Line, Sect Infect Dis, Houston, TX USA

[4] Montefiore Med Ctr, Div Infect Dis, 3411 Wayne Ave 4H, Bronx, NY 10467 USA

来源：

OPEN FORUM INFECTIOUS DISEASES | 2019年 / 6卷 / 06期

关键词：

CPOE; diagnostic stewardship; EMR; health care expenditures; HIV; test ordering; ELECTRONIC HEALTH RECORDS; ANTIRETROVIRAL THERAPY; IMPROVE; SYSTEM; ERA; IMPLEMENTATION; MANAGEMENT; PHYSICIANS; BENEFITS; IMPACT;

D O I：

10.1093/ofid/ofz158

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Inpatient HIV care often requires specialized laboratory testing with which practitioners may not be familiar. In addition, computerized physician order entry allows for ordering tests without understanding test indications, but it can also provide a venue for education and diagnostic stewardship. Methods. All charts of HIV-positive patients hospitalized at a tertiary care public safety net hospital in Houston, Texas, between January 1, 2014, and June 30, 2014, were reviewed for a set list of laboratory tests. Appropriateness of test ordering was assessed by 2 providers. Cost estimates for each test were obtained from Medicaid and a national nonprofit health care charge database. Results. A total of 274 HIV-positive patients were admitted 429 times in the 6-month study period. During the study period, 45% of the study laboratory tests ordered were not indicated. A total of 532 hepatitis serologies were ordered, only 52% of which were indicated. Overall, 71 serum qualitative cytomegalovirus (CMV) polymerase chain reactions (PCRs) and eight CMV quantitative PCRs were ordered, with most (85%) qualitative PCRs ordered for nonspecific signs of infection (eg, fever). Other tests ordered without clear indications included Aspergillus IgE (7), serum Epstein-Barr virus (EBV) PCR (5), parvovirus serology (7), and Toxoplasma IgM (18). Overall, the estimated laboratory cost of inappropriate testing over the study period was between $14 000 and $92 000, depending on which cost database was used. Conclusions. Many tests ordered in HIV-positive inpatients do not have indications, representing a substantial source of health care waste and cost and potentially leading to inappropriate treatment. Opportunities exist to decrease waste through education of trainees and hospitalists and through implementation of diagnostic stewardship via the electronic medical record.

引用

页数：14