Journal of Pathology Informatics

BRIEF REPORT
Year
: 2020  |  Volume : 11  |  Issue : 1  |  Page : 8-

Value-Based intervention with hospital and pathology laboratory informatics: A case of analytics and outreach at the veterans affairs


Gregory D Scott1, Thomas F Osborne2, Sang P Gross4, Dean Fong1 
1 Department of Pathology, Stanford University School of Medicine, Stanford; Department of Pathology, Palo Alto Division, Veterans Affairs Health Care System, Palo Alto, CA, USA
2 Department of Radiology, Stanford University School of Medicine, Stanford; Department of Radiology, VA Palo Alto Healthcare System, Veterans Affairs Health Care System, Palo Alto, CA, USA

Correspondence Address:
Dr. Gregory D Scott
Department of Pathology, Stanford University School of Medicine, Stanford, CA
USA

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.


How to cite this article:
Scott GD, Osborne TF, Gross SP, Fong D. Value-Based intervention with hospital and pathology laboratory informatics: A case of analytics and outreach at the veterans affairs.J Pathol Inform 2020;11:8-8


How to cite this URL:
Scott GD, Osborne TF, Gross SP, Fong D. Value-Based intervention with hospital and pathology laboratory informatics: A case of analytics and outreach at the veterans affairs. J Pathol Inform [serial online] 2020 [cited 2020 Apr 7 ];11:8-8
Available from: http://www.jpathinformatics.org/article.asp?issn=2153-3539;year=2020;volume=11;issue=1;spage=8;epage=8;aulast=Scott;type=0