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Clinical decision rules for the use of liquor diagnostics in hospitalized neurology patients reduced costs without affecting clinical outcomes

Published online by Cambridge University Press:  31 March 2009

Elisabeth Haschke-Becher ,
Uwe Totzke ,
Shahrzad Afazel ,
Tim Johansson ,
Markus Schwarz ,
Gunther Ladurner  and
Claudia Wild
Elisabeth Haschke-Becher
Affiliation:
Paracelsus Medical University of Salzburg
Uwe Totzke
Affiliation:
TOTZKE SCIENTIFIC
Shahrzad Afazel
Affiliation:
Paracelsus Medical University of Salzburg
Tim Johansson
Affiliation:
Paracelsus Medical University of Salzburg
Markus Schwarz
Affiliation:
Paracelsus Medical University of Salzburg
Gunther Ladurner
Affiliation:
Paracelsus Medical University of Salzburg
Claudia Wild
Affiliation:
Ludwig Boltzmann Society
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Abstract

Objectives: Excessive use of laboratory diagnostics has been common. This study aimed to evaluate whether clinical decision rules for the use of liquor diagnostics would enable cost containment without affecting medical care.

Methods: This was a single-center, retrospective, cost-minimization study based on the records of all 16,319 patients hospitalized and discharged at a Neurology Clinic in Austria between 2004 and 2006. Cost of liquor diagnostics, discharge diagnosis, duration of hospital stay, and mortality were compared along the line before, during, and after implementation of decision rules in mid-2005.

Results: There were no significant changes in patient characteristics over time, not in the diagnoses at discharge, nor in the percentage of patients undergoing liquor diagnostics. The average number of tests per patient significantly decreased. Standard tests largely replaced serological tests for infections, regardless of diagnosis. Annual costs for liquor diagnostics decreased by 32.9 percent. Overall, the duration of hospital stay and mortality significantly decreased as well; however, differences were not significant for any single diagnosis-related group.

Conclusions: Diagnostic algorithms may allow cost containment without affecting medical care.

Keywords

LiquorDiagnosticsCost-savingObservational study
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 2 , April 2009 , pp. 208 - 213
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

1. Axt-Adam, P, Van Der Wouden, JC, Van Der Does, E. Influencing behavior of physicians ordering laboratory tests: A literature study. Med Care. 1993;31:784–794.CrossRefGoogle ScholarPubMed
2. Barreto, AM, Takei, K, E C, S et al. , Cost-effective analysis of different algorithms for the diagnosis of hepatitis C virus infection. Braz J Med Biol Res. 2008;41:126–134.CrossRefGoogle ScholarPubMed
3. Berg, J, Lindgren, P. Economic evaluation of FE(NO) measurement in diagnosis and 1-year management of asthma in Germany. Respir Med. 2008;102:219–231.CrossRefGoogle ScholarPubMed
4. Bloom, BS. Effects of continuing medical education on improving physician clinical care and patient health: A review of systematic reviews. Int J Technol Assess Health Care. 2005;21:380–385.CrossRefGoogle Scholar
5. Bogavac-Stanojevic, N, Ivanova Petrova, G, Jelic-Ivanovic, Z, Memon, L, Spasic, S. Cost-effectiveness analysis in diagnosis of coronary artery disease: Choice of laboratory markers. Clin Biochem. 2007;40:1180–1187.CrossRefGoogle ScholarPubMed
6. Bunting, PS, Van Walraven, C. Effect of a controlled feedback intervention on laboratory test ordering by community physicians. Clin Chem. 2004;50:321–326.CrossRefGoogle ScholarPubMed
7. Chuck, A, Ohinmaa, A, Tilley, P, Singh, A, Jacobs, P. Cost effectiveness of enzyme immunoassay and immunoblot testing for the diagnosis of syphilis. Int J STD AIDS. 2008;19:393–399.CrossRefGoogle ScholarPubMed
8. DGHM. MiQ 17/2001. Infektionen des Zentralnervensystems. Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik. Munich: Urban & Fischer; 2001.Google Scholar
9. Dowdy, DW, O'Brien, MA, Bishai, D. Cost-effectiveness of novel diagnostic tools for the diagnosis of tuberculosis. Int J Tuberc Lung Dis. 2008;12:1021–1029.Google ScholarPubMed
10. Dowling, PT, Alfonsi, G, Brown, MI, Culpepper, L. An education program to reduce unnecessary laboratory tests by residents. Acad Med. 1989;64:410–12.CrossRefGoogle ScholarPubMed
11. Gortmaker, SL, Bickford, AF, Mathewson, HO, Dumbaugh, K, Tirrell, PC. A successful experiment to reduce unnecessary laboratory use in a community hospital. Med Care. 1988;26:631–642.CrossRefGoogle Scholar
12. Jackson, BR. Managing laboratory test use: Principles and tools. Clin Lab Med. 2007;27:733–748.CrossRefGoogle ScholarPubMed
13. Lewandrowski, K. Managing utilization of new diagnostic tests. Clin Leadersh Manag Rev. 2003;17:318–324.Google ScholarPubMed
14. Martin, AR. Common and correctable errors in diagnostic test ordering. West J Med. 1982;136:456–461.Google ScholarPubMed
15. Muller, A, Stratmann-Schone, D, Klose, T, Leidl, R. Overview of economic evaluation of positron-emission tomography. Eur J Health Econ. 2002;3:59–65.CrossRefGoogle ScholarPubMed
16. O'Brien, MA, Oxman, AD, Davis, DA et al. , Audit and feedback versus alternative strategies: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 1998;(1):CD000260.Google Scholar
17. Oostenbrink, R, Oostenbrink, JB, Moons, KG et al. , Cost-utility analysis of patient care in children with meningeal signs. Int J Technol Assess Health Care. 2002;18:485–496.Google ScholarPubMed
18. Oostenbrink, R, Oostenbrink, JB, Moons, KG et al. , Application of a diagnostic decision rule in children with meningeal signs: A cost-minimization study. Int J Technol Assess Health Care. 2003;19:698–704.CrossRefGoogle ScholarPubMed
19. Polage, CR, Petti, CA. Assessment of the utility of viral culture of cerebrospinal fluid. Clin Infect Dis. 2006;43:1578–1579.CrossRefGoogle ScholarPubMed
20. Rafeh, N, el-Tobgi, D. Clinical practice and the use of laboratory tests at the May 15 Hospital in Egypt. Int J Qual Health Care. 1995;7:25–30.CrossRefGoogle ScholarPubMed
21. Sood, R, Sood, A, Ghosh, AK. Non-evidence-based variables affecting physicians' test-ordering tendencies: A systematic review. Neth J Med. 2007;65:167–177.Google ScholarPubMed
22. Verstappen, WH, Van Der Weijden, T, Dubois, WI et al. , Improving test ordering in primary care: The added value of a small-group quality improvement strategy compared with classic feedback only. Ann Fam Med. 2004;2:569–575.CrossRefGoogle ScholarPubMed
23. Verstappen, WH, Van Der Weijden, T, Sijbrandij, J et al. , Effect of a practice-based strategy on test ordering performance of primary care physicians: A randomized trial. JAMA. 2003;289;2407–2412.CrossRefGoogle ScholarPubMed
24. Wachtel, TJ, O'Sullivan, P. Practice guidelines to reduce testing in the hospital. J Gen Intern Med. 1990;5:335–341.CrossRefGoogle ScholarPubMed