Journal of Pathology Informatics Journal of Pathology Informatics
Contact us | Home | Login   |  Users Online: 781  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 


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


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
3 Department of Pathology, Palo Alto Division, 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
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpi.jpi_67_19

Rights and Permissions

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.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed765    
    Printed46    
    Emailed0    
    PDF Downloaded123    
    Comments [Add]    

Recommend this journal