Rational, cost effective use of investigations

Bulusu, S

doi:10.1136/bmj.325.7357.222/a

Cited by 11 publications

(4 citation statements)

References 8 publications

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“…In the era of precision medicine and value-based healthcare, the world "routine" has to be banished [9]. In a limited resource setting such us national health care systems, every intervention has to be evidence-based and tailored to patient's needs to allow for optimal resources allocation.…”

Section: Discussionmentioning

confidence: 99%

Routine pathology examination in the era of value-based healthcare: the case of haemorrhoids specimens

et al. 2020

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Routine pathologic examination of specimens is a common practice with ill-defined value. The present study is the first to investigate the incidence and cost of incidental microscopic lesions in both haemorrhoidectomy and stapled haemorrhoidopexy specimens. Pathological reports of specimens obtained from haemorrhoidectomy and stapled haemorrhoidopexy procedures performed from January 2003 to May 2017 were analysed. Specimens resulting from patients treated for any disease other than haemorrhoids alone were excluded from the study. Unexpected diagnoses in the pathological report were defined as incidental diagnoses. A cost analysis was then performed. In the considered period we performed a total of 3017 procedures complying with our criteria. We found 65 (2.15%) unexpected lesions. Of the incidental diagnosis, 30 (0.99%) altered either the follow-up or the treatment. The incidences of both findings were extremely higher in haemorrhoidectomies specimens (p < 0.0001). We estimated that the cost of 14 years of routine pathological examination of haemorrhoids specimens was 133,351.4 euros, each consequential incidental diagnosis costing 4445.03 euros. The incidence of unexpected lesions in routine pathologic examination of haemorrhoidectomy and haemorrhoidopexy specimens is low but not negligible. The vast majority of incidental findings were found among haemorrhoidectomy specimens. Even though the real value of routine pathological examination of haemorrhoids specimens is still uncertain, from a clinical standpoint we were glad to suggest each patients the best follow-up and/or treatment. Future studies should assess preoperative patient's risk stratification and careful intraoperative macroscopic inspection strategies for selective pathology examination of haemorrhoids specimens.

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Section: Discussionmentioning

confidence: 99%

Routine pathology examination in the era of value-based healthcare: the case of haemorrhoids specimens

et al. 2020

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“…Em suma, considerando-se a base de exames estudados, o ambulatório de Cardiologia (CAA) foi onde houve o maior número de exames/paciente observados (10,36), em comparação com o de Endocrinologia (5,91). Tal diferença pode ser explicada em razão do menor número de pacientes nesse último ambulatório e, consequentemente, do menor número de exames analisados, o que é resultante, por conseguinte, de em uma base mais reduzida de pacientes, bem como por causa da diferença de fatores de prevalência e demanda das doenças nos dois ambulatórios estudados.…”

Section: ▄ Métodounclassified

“…Dessa forma, os exames diagnósticos estão totalmente ligados às políticas públicas de saúde e inseridos nelas ao representarem um importante papel na prevenção, no diagnóstico, no tratamento e no acompanhamento das enfermidades em geral, sendo preponderantes para a qualidade de vida do paciente. Esses exames diagnósticos podem ser divididos nas categorias de análises clínicas e de diagnóstico por imagem 4,5 .…”

Section: ▄ Introduçãounclassified

Avaliação da solicitação de exames laboratoriais em um hospital universitário: consequências para a clínica e a gestão

Gomes

Nunes

2019

Cad. saúde colet.

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Resumo Introdução Os princípios estabelecidos pelo SUS fizeram com que o atual cenário da saúde pública ganhasse complexidade envolvendo o financiamento e o suporte para a sustentabilidade do sistema. Há relatos sobre o excesso no uso de recursos diagnósticos, muitas vezes desnecessários, com consequências para os pacientes e o orçamento dos serviços de saúde, sobretudo hospitais. Objetivo Avaliar os resultados qualitativos e quantitativos de exames laboratoriais solicitados nos ambulatórios de Cardiologia e Endocrinologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Método Foi realizado um estudo transversal com análise dos exames solicitados nos ambulatórios de Endocrinologia e Cardiologia entre julho/2012 e julho/2013. Resultados A quantidade de exames foi semelhante ao longo dos 12 meses, e a relação de exames/paciente foi maior no ambulatório de Cardiologia, com 10,36 exames, do que no ambulatório de Endocrinologia, com os 5,91 exames. Analisando os subelementos dos exames, os resultados foram próximos: em Cardiologia, a taxa média de elementos alterados foi de 20,79%, ao passo que, em Endocrinologia, o valor médio foi de 22,39%. Conclusão Entender o comportamento de médicos na solicitação dos exames laboratoriais em um hospital de grande porte pode estimular os líderes e os gestores a buscar propostas para melhorar o gerenciamento desses grandes centros de alta complexidade assistencial, buscando a eficiência e a qualidade na assistência e no ensino.

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“… 17 There is variable evidence of the effectiveness of these strategies as they are effective in some contexts and ineffective in others. 18 In addition, some hospital settings have implemented a single strategy while others have implemented a multi-pronged approach.…”

Section: Introductionmentioning

confidence: 99%

Impact of novel software on laboratory expenditure at an academic hospital in South Africa

Mayekiso,

Oladimeji,

Estrada

et al. 2023

African Journal of Laboratory Medicine

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Background: Countries across the globe report an increase in expenditure associated with medical laboratory testing. In 2020, the United States Department of Health and Human Services reported that laboratory test expenditures increased by $459 million US dollars (USD) from $7.1 billion USD in 2018. In South Africa, laboratory testing expenditure in the public sector increased from $415 million USD in 2014 to $723 million USD in 2021.Objective: This study aimed to evaluate the impact of an innovative software, electronic gatekeeping (EGK), on medical laboratory test expenditures at Nelson Mandela Academic Hospital, in the Eastern Cape, South Africa.Methods: In this cross-sectional study, an interrupted time series analysis technique was used to evaluate trends in expenditure during a 48-month study period. To measure the impact of EGK on laboratory expenditure, we analysed laboratory expenditure over two study periods: a period of 24 months occurring before EGK implementation (01 June 2013 to 31 May 2015) and a period of 24 months occurring during EGK implementation (01 June 2015 to 30 May 2017).Results: There was a significant reduction (211 928 fewer tests) in the number of tests performed during the intervention (434 790) compared to before the intervention (646 718). Laboratory test expenditure was $1 663 756.72 USD before the intervention period and $1 105 036.88 USD during the intervention period, demonstrating a cost savings of $558 719.84 USD.Conclusion: Electronic gatekeeping is a cost-effective intervention for managing medical laboratory expenditures. We recommend that the health sector scale up this intervention nationally.What this study adds: Using an interrupted time series interval, the authors determined that EGK is a cost-effective intervention for managing medical laboratory expenditures at a tertiary hospital. This study’s findings can promote and contribute to improved laboratory systems and test investigations.

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Rational, cost effective use of investigations

Cited by 11 publications

References 8 publications

Routine pathology examination in the era of value-based healthcare: the case of haemorrhoids specimens

Routine pathology examination in the era of value-based healthcare: the case of haemorrhoids specimens

Avaliação da solicitação de exames laboratoriais em um hospital universitário: consequências para a clínica e a gestão

Impact of novel software on laboratory expenditure at an academic hospital in South Africa

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