Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital.
<h4>Background</h4>Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse a...
| Автори: | , , , , , , , |
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| Формат: | Стаття |
| Мова: | English |
| Опубліковано: |
Public Library of Science (PLoS)
2020-01-01
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| Серія: | PLoS ONE |
| Онлайн доступ: | https://doi.org/10.1371/journal.pone.0237159 |
| _version_ | 1830441338946977792 |
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| author | Andrea Tamburrano Doriana Vallone Cinzia Carrozza Andrea Urbani Maurizio Sanguinetti Nicola Nicolotti Andrea Cambieri Patrizia Laurenti |
| author_facet | Andrea Tamburrano Doriana Vallone Cinzia Carrozza Andrea Urbani Maurizio Sanguinetti Nicola Nicolotti Andrea Cambieri Patrizia Laurenti |
| author_sort | Andrea Tamburrano |
| collection | DOAJ |
| description | <h4>Background</h4>Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse and to estimate the cost of the inappropriate requests in a large university hospital.<h4>Method</h4>In this observational study, hospital physicians submitted the examination requests for the inpatients through a Computerized Physician Order Entry. Violations of the rules in tests requests were intercepted and counted by a CCDSS, over a period of 20 months. Descriptive and inferential statistics (Student's t-test and ANOVA) were made. Finally, the monthly comprehensive cost of the laboratory tests was calculated.<h4>Results</h4>During the observation period a total of 5,716,370 requests were analyzed and 809,245 violations were counted. The global rate of overuse was 14.2% ± 3.0%. The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis Nucleic Acid Amplification (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). The monthly cost of over-utilization was 56,534€ for basic panel, 14,421€ for coagulation, 4,758€ for microbiology, 432€ for immunology exams. All the exams, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital.<h4>Conclusions</h4>The study confirms the wide variability in over-utilization rates of laboratory tests. For these reasons, the real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exams that is useful not only to reduce costs, but also to ensure standardization and high-quality care. |
| first_indexed | 2024-12-21T05:19:10Z |
| format | Article |
| id | doaj.art-4f62f2d77f874b51b7fe2ea78a42c3ce |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T05:19:10Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-4f62f2d77f874b51b7fe2ea78a42c3ce2022-12-21T19:14:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01158e023715910.1371/journal.pone.0237159Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital.Andrea TamburranoDoriana ValloneCinzia CarrozzaAndrea UrbaniMaurizio SanguinettiNicola NicolottiAndrea CambieriPatrizia Laurenti<h4>Background</h4>Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse and to estimate the cost of the inappropriate requests in a large university hospital.<h4>Method</h4>In this observational study, hospital physicians submitted the examination requests for the inpatients through a Computerized Physician Order Entry. Violations of the rules in tests requests were intercepted and counted by a CCDSS, over a period of 20 months. Descriptive and inferential statistics (Student's t-test and ANOVA) were made. Finally, the monthly comprehensive cost of the laboratory tests was calculated.<h4>Results</h4>During the observation period a total of 5,716,370 requests were analyzed and 809,245 violations were counted. The global rate of overuse was 14.2% ± 3.0%. The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis Nucleic Acid Amplification (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). The monthly cost of over-utilization was 56,534€ for basic panel, 14,421€ for coagulation, 4,758€ for microbiology, 432€ for immunology exams. All the exams, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital.<h4>Conclusions</h4>The study confirms the wide variability in over-utilization rates of laboratory tests. For these reasons, the real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exams that is useful not only to reduce costs, but also to ensure standardization and high-quality care.https://doi.org/10.1371/journal.pone.0237159 |
| spellingShingle | Andrea Tamburrano Doriana Vallone Cinzia Carrozza Andrea Urbani Maurizio Sanguinetti Nicola Nicolotti Andrea Cambieri Patrizia Laurenti Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital. PLoS ONE |
| title | Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital. |
| title_full | Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital. |
| title_fullStr | Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital. |
| title_full_unstemmed | Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital. |
| title_short | Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital. |
| title_sort | evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a computerized clinical decision support system ccdss in a large university hospital |
| url | https://doi.org/10.1371/journal.pone.0237159 |
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