کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5876719 1566115 2016 6 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
AJM onlineClinical research studyUnderstanding and Reducing Ceruloplasmin Overuse with a Decision Support Intervention for Liver Disease Evaluation
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی پزشکی و دندانپزشکی (عمومی)
پیش نمایش صفحه اول مقاله
AJM onlineClinical research studyUnderstanding and Reducing Ceruloplasmin Overuse with a Decision Support Intervention for Liver Disease Evaluation
چکیده انگلیسی

BackgroundOver-testing is a source of significant health care costs, both in terms of dollars spent and the false positives generated. Clinicians frequently test patients with elevated liver enzymes (a common problem) for Wilson disease (a rare disease) using a ceruloplasmin level.MethodsWe performed a prospective pre-post study between October 2013 and November 2014. We deployed a pop-up screen in our provider order entry system to present clinicians with the guidelines for and test characteristics of ceruloplasmin use. Outcomes included rate ratios for test utilization. Indications for inpatient orders were provided by ordering clinicians and reviewed.ResultsCeruloplasmin was ordered 448 and 219 times in the pre- and postintervention periods, respectively. Rate ratios for orders from gastroenterologists and general internists were 0.49; 95% confidence interval (CI), 0.40-0.59, and 0.31; 95% CI, 0.20-0.50, respectively (P <.0001, for both). Following the intervention, there was an 82% and 40% decrease in orders by internists in the outpatient and inpatient settings, respectively. Tests of confirmation (necessary for positive ceruloplasmins) were more common in the group tested following the intervention, risk ratio 1.80; 95% CI, 1.04-3.08; P = .02. Of the residual ceruloplasmin orders by inpatient internists after the intervention, 75% (18/24) were recommended by hepatology consultants.ConclusionThe optimal intervention for the reduction of over-testing should include automated changes to the ordering system combined with efforts to change testing culture through education.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: The American Journal of Medicine - Volume 129, Issue 1, January 2016, Pages 115.e17-115.e22
نویسندگان
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