Inappropriate use and interpretation of D-dimer testing in the emergency department: an unexpected adverse effect of meeting the "4-h target"

Jones, P. G.; Elangbam, B; Williams, NR

doi:10.1136/emj.2009.075838

Cited by 20 publications

(17 citation statements)

References 39 publications

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“…Therefore, in a setting of low clinical probability, a positive D‐dimer test is likely to result in unnecessary imaging, especially in emergency departments, where D‐dimer tests may be ordered for any patient with shortness of breath or chest pain before they are assessed by a doctor 14 . ‐ 16 …”

Section: Discussionmentioning

confidence: 99%

Changing trends in venous thromboembolism‐related imaging in Western Australian teaching hospitals, 2002–2010

Segard¹,

Macdonald

2013

Medical Journal of Australia

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Section: Discussionmentioning

confidence: 99%

Changing trends in venous thromboembolism‐related imaging in Western Australian teaching hospitals, 2002–2010

Segard¹,

Macdonald

2013

Medical Journal of Australia

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“…15,[17][18][19] Lack of extended primary care offi ce hours is associated with increased emergency department use, 13,14 increasing the risk of overly aggressive testing and treatment. 16,17 Failure to offer comprehensive health care is associated with more hospitalizations and specialty referrals, 1 again increasing the likelihood of overly aggressive care. Finally, a patient-centered clinician communication style is associated with less diagnostic testing and fewer specialty referrals, probably by more effectively addressing patient health concerns.…”

Section: Discussionmentioning

confidence: 99%

“…10 Increased access to these attributes might also minimize unnecessary and potentially harmful care, 1,[11][12][13][14] thereby mitigating iatrogenic mortality. [15][16][17][18][19] We therefore hypothesized greater patient-reported access to these primary care attributes would be associated with decreased subsequent mortality risk.…”

Section: Introductionmentioning

confidence: 99%

Primary Care Attributes and Mortality: A National Person-Level Study

Jerant¹,

Fenton²,

Franks³

2012

The Annals of Family Medicine

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PURPOSEResearch demonstrates an association between the geographic concentration of primary care clinicians and mortality in the area, but there is limited evidence of a mortality benefi t of primary care at the individual patient level. We examined whether patient-reported access to selected primary care attributes, including some emphasized in the medical home literature, is associated with lower individual mortality risk. A score was constructed from 5 yes/no items assessing whether the respondent's usual source of care had 3 attributes: comprehensiveness, patient-centeredness, and enhanced access. Scores ranged from 0 to 1 (higher scores = more attributes). We examined the association between the primary care attributes score and mortality during up to 6 years of follow-up using Cox survival analysis, adjusted for social, demographic, and health-related characteristics. METHODSRESULTS Racial/ethnic minorities, poorer and less educated persons, individuals without private insurance, healthier persons, and residents of regions other than the Northeast reported less access to primary care attributes than others. The primary care attributes score was inversely associated with mortality (adjusted hazard ratio = 0.79; 95% confi dence interval, 0.64-0.98; P = .03); supplementary analyses showed mortality decreased linearly with increasing score.CONCLUSIONS Greater reported patient access to selected primary care attributes was associated with lower mortality. The fi ndings support the current interest in ensuring that patients have access to a medical home encompassing these attributes.

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“…2 Offering patients extended access to their usual source of care might afford earlier diagnosis and treatment of serious health conditions, potentially preventing catastrophic events, and reducing expenditures. Extended offi ce hours might also limit unnecessary patient exposure to higher-acuity (eg, emergency) care and, therefore, to discretionary and potentially harmful testing, treatments, and hospitalizations [3][4][5] initiated by clinicians unfamiliar with their care, which might further reduce expenditures.…”

Section: Introductionmentioning

confidence: 99%

Extended Office Hours and Health Care Expenditures: A National Study

Jerant

Bertakis

Fenton

et al. 2012

The Annals of Family Medicine

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PURPOSE A key component of primary care improvement efforts is timely access to care; however, little is known regarding the effects of extended (evening and weekend) offi ce hours on health care use and outcomes. We examined the association between reported access to extended offi ce hours and both health care expenditures and mortality. Covariates were year 1 sociodemographics and health care use, and year 2 health insurance, health status, and chronic conditions. We conducted further analyses, progressively adjusting for year 2 use, to explore mechanisms. METHODSRESULTS Total expenditures were 10.4% lower (95% confi dence interval, 7.2%-13.4%) among patients reporting access to extended hours in both years vs neither year. Adjustment for year 2 prescription drug expenditures, and to a lesser extent, offi ce visit-related expenditures (but not total prescriptions or offi ce visits, or emergency and inpatient expenditures) attenuated this relationship. Extended-hours access was not statistically associated with mortality. CONCLUSIONSRespondents reporting a usual source of care offering evening and weekend offi ce hours had lower total health care expenditures than those without extended-hours access, an association related to lower prescription drug and offi ce visit-related (eg, testing) expenditures, without adverse effects on mortality. Although requiring further study, extended offi ce hours may be associated with more judicious use of health care resources.

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Inappropriate use and interpretation of D-dimer testing in the emergency department: an unexpected adverse effect of meeting the "4-h target"

Cited by 20 publications

References 39 publications

Changing trends in venous thromboembolism‐related imaging in Western Australian teaching hospitals, 2002–2010

Changing trends in venous thromboembolism‐related imaging in Western Australian teaching hospitals, 2002–2010

Primary Care Attributes and Mortality: A National Person-Level Study

Extended Office Hours and Health Care Expenditures: A National Study

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