Clinical laboratory management review : official publication of the Clinical Laboratory Management Association / CLMA
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Clin Lab Manage Rev · Mar 1998
Cost-effectiveness of cardiac troponin I in a systematic chest pain evaluation protocol: use of cardiac troponin I lowers length of stay for low-risk cardiac patients.
We evaluated several measures of clinical and fiscal interest to assess the effect of adding an automated cardiac troponin I (c-TnI) assay to our current cardiac panel, which consists of creatine kinase MB (CK-MB), myoglobin, total CK activity, and a calculated CK-MB relative index. Samples were collected on admission and at 3, 6, and 8 hours after admission as part of our diagnostic protocol. ⋯ We found that adding c-TnI to our testing regimen decreased LOS for the large test population. Within this large test population, patients classified as low risk for acute myocardial infarction experienced statistically and clinically significant shorter LOS and lower total and variable hospital costs; for patients with unstable angina, there was an increase (though not statistically significant) in laboratory costs.
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Clin Lab Manage Rev · Mar 1998
Outcomes research is the fifth discipline of the fifth generation of managed care: utility of a single troponin-T.
The fifth generation of managed care is disease management. Diseases have measurable risk in providing laboratory and medical services. The link between managing services and managing risk can be aided by leveraging the laboratory. We wish to remodel laboratory services to fit the needs of the use, thereby using the laboratory for competitive advantage by redesigning a desired output using a formal structured process. Outcomes research is the systems framework for the remodeling process through the link of laboratory output to clinical and financial outcomes. A process redesign model connects the use of laboratory tests to improved medical services by leveraging resources to achieve measurable improvement over current results. This view of outcomes research seeks both competitive advantage and measurable improvements in quality. ⋯ The study supports our hypothesis that the laboratory can systematically redesign its technology strategy and participate in the construction of a clinical pathway for the discharge from ED or admitting decisions with a test 98% sensitive for identifying patients with serious coronary ischemia by 3.5 hours after the onset of symptoms.
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Clin Lab Manage Rev · Mar 1997
Using patient satisfaction as an indicator of the quality of laboratory services. Applying social science methods to evaluate outcomes in laboratory medicine.
The authors discuss methods of outcomes research using patient satisfaction as a quality indicator for evaluating point-of-care (POC) laboratory methods. After commenting on the rationale for using this approach, we focus on specific techniques for developing questionnaires, collecting survey response data, and building a database for analysis. ⋯ Preliminary results thus far show no significant effects from the use of POC prothrombin time testing on hospital inpatient evaluations of their overall care. Using laboratory charges and total reimbursements for treatment as proxies for cost, we found a significant (p < 0.0001) difference in the costs for POC testing over those for testing in the central laboratory.
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Clin Lab Manage Rev · Mar 1996
Effective resource management using a clinical and laboratory algorithm for chest pain triage.
Bridgeport Hospital recently compared the use of a clinical algorithm with unaided physicians for the triage of 200 emergency department (ED) patients with chest pain for coronary care unit (CCU) admission. ⋯ Creatine kinase and its MB isoenzyme (CK-MB) are measured at the time of clinical triage and 4, 8, and 12 hours later. LD1 and total lactase dehydrogenase are measured 12 hours after initial sampling. Cardiac troponin-T is measured at the time of ED arrival and 4 hours later. ANALYSIS OF BENEFIT: The first thing to consider is reducing the cost from stress thalliums for low risk evaluation. The second is the evaluation of active ischemia--unstable angina and diagnosis of missed AMI. The Goldman algorithm eliminates unnecessary admissions to the CCU for chest pain, including unstable angina. There is a difference between AMI and triage for CCU admission (200 patients). CK-MBs allowed for the elimination of 37 non-AMIs. However, we missed eight cases of AMI that would have been LD1 positive (troponin positive) and gained 10 cases of unstable angina that should have been assigned to CCU or a monitored bed. Troponin found six more cases of unstable angina that were CK-MB negative but should have been class 3 unstable angina that could be assigned to at least a telemetry bed. This makes 14 cases of AMI or unstable angina unaccounted for by CK-MB (5.6%). All of the cases were at risk of ventricular arrhythmia within 36 hours. The only question was whether to assign them to CCU or to monitored beds. The third point in the analysis is to examine the savings in operating costs by substitution. The cost model, in selecting a strategy, takes test costs, clinical outcomes, and the cost of clinical algorithms into consideration.