Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration

Abstract Background Clinical practice guidelines discourage routine preoperative screening tests for patients undergoing low-risk procedures. This study sought to determine the frequency and costs of potentially low-value preoperative screening tests in Veterans Health Administration (VA) patients u...

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Main Authors: Alex H. S. Harris, Thomas Bowe, Robin N. Kamal, Erika D. Sears, Mary Hawn, Dan Eisenberg, Andrea K. Finlay, Hildi J. Hagedorn, Seshadri Mudumbai
Format: Article
Language:English
Published: BMC 2022-09-01
Series:Perioperative Medicine
Subjects:
Online Access:https://doi.org/10.1186/s13741-022-00265-0
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author Alex H. S. Harris
Thomas Bowe
Robin N. Kamal
Erika D. Sears
Mary Hawn
Dan Eisenberg
Andrea K. Finlay
Hildi J. Hagedorn
Seshadri Mudumbai
author_facet Alex H. S. Harris
Thomas Bowe
Robin N. Kamal
Erika D. Sears
Mary Hawn
Dan Eisenberg
Andrea K. Finlay
Hildi J. Hagedorn
Seshadri Mudumbai
author_sort Alex H. S. Harris
collection DOAJ
description Abstract Background Clinical practice guidelines discourage routine preoperative screening tests for patients undergoing low-risk procedures. This study sought to determine the frequency and costs of potentially low-value preoperative screening tests in Veterans Health Administration (VA) patients undergoing low-risk procedures. Methods Using the VA Corporate Data Warehouse, we identified Operative Stress Score class 1 procedures (“very minor”) performed without general anesthesia in VA during fiscal year 2019 and calculated the overall national and facility-level rates and costs of nine common tests received in the 30 preoperative days. Patient factors associated with receiving at least one screening test, and the number of tests received, were examined. Results Eighty-six thousand three hundred twenty-seven of 178,775 low-risk procedures (49.3%) were preceded by 321,917 potentially low-value screening tests representing $11,505,170 using Medicare average costs. Complete blood count was the most common (33.2% of procedures), followed by basic metabolic profile (32.0%), urinalysis (26.3%), electrocardiography (18.9%), and pulmonary function test (12.4%). Older age, female sex, Black race, and having more comorbidities were associated with higher odds of low-value testing. Transthoracic echocardiogram occurred prior to only 4.5% of the procedures but accounted for 47.8% of the total costs ($5,499,860). In 129 VA facilities, the facility-level proportion of procedures preceded by at least one test ranged from 0 to 81.2% and facility-level costs ranged from $0 to $388,476. Conclusions Routine preoperative screening tests for very low-risk procedures are common and costly in some VA facilities. These results highlight a potential target to improve quality and value by reducing unnecessary care. Measures of low-value perioperative care could be integrated into VA’s extensive quality monitoring and improvement infrastructure.
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spelling doaj.art-cde8c29c205a45068796c58b5b4db2262022-12-22T02:04:14ZengBMCPerioperative Medicine2047-05252022-09-011111810.1186/s13741-022-00265-0Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administrationAlex H. S. Harris0Thomas Bowe1Robin N. Kamal2Erika D. Sears3Mary Hawn4Dan Eisenberg5Andrea K. Finlay6Hildi J. Hagedorn7Seshadri Mudumbai8Center for Innovation to Implementation, VA Palo Alto Healthcare SystemCenter for Innovation to Implementation, VA Palo Alto Healthcare SystemDepartment of Orthopedic Surgery, Stanford University School of MedicineCenter for Clinical Management Research, VA Ann Arbor Health Care System, Michigan Medicine Department of SurgeryCenter for Innovation to Implementation, VA Palo Alto Healthcare SystemCenter for Innovation to Implementation, VA Palo Alto Healthcare SystemCenter for Innovation to Implementation, VA Palo Alto Healthcare SystemCenter for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Medical Center, Department of Psychiatry, University of Minnesota School of MedicineCenter for Innovation to Implementation, VA Palo Alto Healthcare SystemAbstract Background Clinical practice guidelines discourage routine preoperative screening tests for patients undergoing low-risk procedures. This study sought to determine the frequency and costs of potentially low-value preoperative screening tests in Veterans Health Administration (VA) patients undergoing low-risk procedures. Methods Using the VA Corporate Data Warehouse, we identified Operative Stress Score class 1 procedures (“very minor”) performed without general anesthesia in VA during fiscal year 2019 and calculated the overall national and facility-level rates and costs of nine common tests received in the 30 preoperative days. Patient factors associated with receiving at least one screening test, and the number of tests received, were examined. Results Eighty-six thousand three hundred twenty-seven of 178,775 low-risk procedures (49.3%) were preceded by 321,917 potentially low-value screening tests representing $11,505,170 using Medicare average costs. Complete blood count was the most common (33.2% of procedures), followed by basic metabolic profile (32.0%), urinalysis (26.3%), electrocardiography (18.9%), and pulmonary function test (12.4%). Older age, female sex, Black race, and having more comorbidities were associated with higher odds of low-value testing. Transthoracic echocardiogram occurred prior to only 4.5% of the procedures but accounted for 47.8% of the total costs ($5,499,860). In 129 VA facilities, the facility-level proportion of procedures preceded by at least one test ranged from 0 to 81.2% and facility-level costs ranged from $0 to $388,476. Conclusions Routine preoperative screening tests for very low-risk procedures are common and costly in some VA facilities. These results highlight a potential target to improve quality and value by reducing unnecessary care. Measures of low-value perioperative care could be integrated into VA’s extensive quality monitoring and improvement infrastructure.https://doi.org/10.1186/s13741-022-00265-0Preoperative testingSurgical careValueEfficiencyImplementation
spellingShingle Alex H. S. Harris
Thomas Bowe
Robin N. Kamal
Erika D. Sears
Mary Hawn
Dan Eisenberg
Andrea K. Finlay
Hildi J. Hagedorn
Seshadri Mudumbai
Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration
Perioperative Medicine
Preoperative testing
Surgical care
Value
Efficiency
Implementation
title Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration
title_full Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration
title_fullStr Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration
title_full_unstemmed Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration
title_short Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration
title_sort frequency and costs of low value preoperative tests for patients undergoing low risk procedures in the veterans health administration
topic Preoperative testing
Surgical care
Value
Efficiency
Implementation
url https://doi.org/10.1186/s13741-022-00265-0
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