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[PMID]:29182678
[Au] Autor:Wilke P; Masuch A; Fahron O; Zylla S; Leipold T; Petersmann A
[Ad] Endereço:Central Emergency Department, Klinikum Frankfurt (Oder) GmbH, Rhön AG, Frankfurt (Oder), Germany.
[Ti] Título:Diagnostic performance of point-of-care and central laboratory cardiac troponin assays in an emergency department.
[So] Source:PLoS One;12(11):e0188706, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Early diagnosis of myocardial infarction (MI) with cardiac troponin (cTn) assays at the point-of-care (POC) is suggested to shorten turn-around-time in the emergency department (ED). The present study aimed at comparing the diagnostic performance of two POC cTn assays with that of a central laboratory high-sensitivity (hs) method, under routine ED conditions. In 2,163 non-selected ED patients suspected for MI, the diagnostic performance of the POC troponin I (TnI), troponin T (TnT), and hs-TnT assay for the prediction of MI was evaluated based on receiver operating characteristic (ROC) analyses and compared with the performance based on the manufacturers' cut-offs. Due to an observed association between renal function as determined by estimated glomerular filtration rate (eGFR) and cTn concentrations, all analyses were stratified by renal function. In patients with normal renal function (eGFR > 60 mL/min/1.73m2), POC and hs assays showed a comparable diagnostic performance as quantified by the area under the ROC curve (AUC) of about 0.88. The ROC-derived optimal cut-off (OCO) levels for the different cTn assays clearly changed with decreasing kidney function. Impaired kidney function required OCO to be three to five times higher to achieve a comparable performance. Particularly cTnT concentrations were strongly associated with renal function. The three cTn assays demonstrated equivalent diagnostic performance in ED-patients admitted with suspected ACS in relation to the release diagnosis, supporting the use of POC testing in this setting. The present results implicate that application of eGFR-specific OCOs may decrease false-positives among patients with impaired renal function. Providing individual cut-offs depending on patients' eGFR might be an appropriate add-on tool to improve specificity in the diagnosis of MI.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência
Infarto do Miocárdio/diagnóstico
Sistemas Automatizados de Assistência Junto ao Leito
Troponina I/sangue
Troponina T/sangue
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Feminino
Seres Humanos
Laboratórios Hospitalares
Masculino
Meia-Idade
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Troponin I); 0 (Troponin T)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188706


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[PMID]:28898984
[Au] Autor:Rudolf JW; Dighe AS; Coley CM; Kamis IK; Wertheim BM; Wright DE; Lewandrowski KB; Baron JM
[Ad] Endereço:Departments of Pathology.
[Ti] Título:Analysis of Daily Laboratory Orders at a Large Urban Academic Center: A Multifaceted Approach to Changing Test Ordering Patterns.
[So] Source:Am J Clin Pathol;148(2):128-135, 2017 Aug 01.
[Is] ISSN:1943-7722
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objectives: We sought to address concerns regarding recurring inpatient laboratory test order practices (daily laboratory tests) through a multifaceted approach to changing ordering patterns. Methods: We engaged in an interdepartmental collaboration to foster mindful test ordering through clinical policy creation, electronic clinical decision support, and continuous auditing and feedback. Results: Annualized daily order volumes decreased from approximately 25,000 to 10,000 during a 33-month postintervention review. This represented a significant change from preintervention order volumes (95% confidence interval, 0.61-0.64; P < 10-16). Total inpatient test volumes were not affected. Conclusions: Durable changes to inpatient order practices can be achieved through a collaborative approach to utilization management that includes shared responsibility for establishing clinical guidelines and electronic decision support. Our experience suggests auditing and continued feedback are additional crucial components to changing ordering behavior. Curtailing daily orders alone may not be a sufficient strategy to reduce in-laboratory costs.
[Mh] Termos MeSH primário: Sistemas de Apoio a Decisões Clínicas
Testes Diagnósticos de Rotina/utilização
Sistemas de Registro de Ordens Médicas
Padrões de Prática Médica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos
Seres Humanos
Laboratórios Hospitalares/utilização
Procedimentos Desnecessários/estatística & dados numéricos
Procedimentos Desnecessários/utilização
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170914
[St] Status:MEDLINE
[do] DOI:10.1093/ajcp/aqx054


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[PMID]:28750704
[Au] Autor:Colombo A; Giannini F; Briguori C
[Ad] Endereço:Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy. Electronic address: colombo.antonio@hsr.it.
[Ti] Título:Should We Still Have Bare-Metal Stents Available in Our Catheterization Laboratory?
[So] Source:J Am Coll Cardiol;70(5):607-619, 2017 Aug 01.
[Is] ISSN:1558-3597
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The introduction of bare-metal stents (BMS) has represented a major advancement over plain old balloon angioplasty in the management of coronary artery disease. However, the high rates of target lesion revascularization associated with use of BMS have led to the development of drug-eluting stents, which require prolonged dual antiplatelet therapy due to the increased risk of late and very late stent thrombosis. The improvements in newer-generation drug-eluting stents have translated into better safety and efficacy compared with earlier generation and BMS, thus allowing shorter dual antiplatelet therapy duration. Here, we aim to provide reasons as to why we still need BMS in our cardiac catheterization laboratory.
[Mh] Termos MeSH primário: Cateterismo Cardíaco
Doença da Artéria Coronariana/cirurgia
Laboratórios Hospitalares
Stents/provisão & distribuição
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170729
[St] Status:MEDLINE


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[PMID]:28688743
[Au] Autor:Albertini AF; Raoux D; Neumann F; Rossat S; Tabet F; Pedeutour F; Duranton-Tanneur V; Kubiniek V; Vire O; Weinbreck N
[Ad] Endereço:Laboratoire Médipath, pôle d'excellence Jean-Louis, 263, Via Nova, 83600 Fréjus, France. Electronic address: af.albertini@medipath.com.
[Ti] Título:[Detection of RAS genes mutation using the Cobas method in a private laboratory of pathology: Medical and economical study in comparison to a public platform of molecular biology of cancer].
[Ti] Título:Analyse des mutations des gènes RAS par technique Cobas au sein d'une structure de pathologie libérale : étude médico-économique et moléculaire comparative avec une plateforme labellisée INCa..
[So] Source:Bull Cancer;104(7-8):662-674, 2017 Jul - Aug.
[Is] ISSN:1769-6917
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:In France, determination of the mutation status of RAS genes for predictive response to anti-EGFR targeted treatments is carried out by public platforms of molecular biology of cancer created by the French National Cancer Institute. This study aims to demonstrate the feasibility of these analyses by a private pathology laboratory (MEDIPATH) as per the requirements of accreditation. We retrospectively studied the mutation status of KRAS and NRAS genes in 163 cases of colorectal metastatic cancer using the Cobas technique. We compared our results to those prospectively obtained through pyrosequencing and allelic discrimination by the genetic laboratory of solid tumors at the Nice University Hospital (PACA-EST regional platform). The results of both series were identical: 98.7% positive correlation; negative correlation of 93.1%; overall correlation of 95.7% (Kappa=0.92). This study demonstrates the feasibility of molecular analysis in a private pathology laboratory. As this practice requires a high level of guarantee, its accreditation, according to the NF-EN-ISO15189 quality compliance French standard, is essential. Conducting molecular analysis in this context avoids the steps of routing the sample and the result between the pathology laboratory and the platform, which reduces the overall time of rendering the result. In conclusion, the transfer of some analysis from these platforms to private pathology laboratories would allow the platforms to be discharged from a part of routine testing and therefore concentrate their efforts to the development of new analyses constantly required to access personalized medicine.
[Mh] Termos MeSH primário: Acreditação
Neoplasias Colorretais/genética
Análise Mutacional de DNA/métodos
Genes ras
Laboratórios Hospitalares/normas
Mutação
[Mh] Termos MeSH secundário: Neoplasias Colorretais/patologia
Análise Mutacional de DNA/economia
Análise Mutacional de DNA/normas
Éxons
Estudos de Viabilidade
França
Seres Humanos
Laboratórios Hospitalares/economia
Estudos Prospectivos
Receptor do Fator de Crescimento Epidérmico/antagonistas & inibidores
Reprodutibilidade dos Testes
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
EC 2.7.10.1 (Receptor, Epidermal Growth Factor)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170815
[Lr] Data última revisão:
170815
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE


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[PMID]:28672402
[Au] Autor:Gill PJ; Richardson SE; Ostrow O; Friedman JN
[Ad] Endereço:Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
[Ti] Título:Testing for Respiratory Viruses in Children: To Swab or Not to Swab.
[So] Source:JAMA Pediatr;171(8):798-804, 2017 Aug 01.
[Is] ISSN:2168-6211
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: While most viral respiratory tract infections can be diagnosed clinically, clinicians frequently order tests to identify the specific offending virus. While there has been tremendous growth in the variety, availability, and sophistication of the types of respiratory viral tests, there may have been less critical thought and discussion among frontline clinicians about the clinical utility and specific indications for testing. We summarize the rationale historically used to support respiratory virus testing in children, with a review of the supporting evidence. We outline potential considerations and limitations of the various types of respiratory viral tests and suggest some clinical indications where viral testing may play an important role in clinical management. Observations: The main value of testing for viruses in children who present with a respiratory tract infection is to differentiate between viral and bacterial infections, hopefully facilitating clinical decision making regarding further investigations and the need for antibiotics. We have highlighted commonly cited rationale used to support testing and the generally poor evidence on which to base this rationale. In addition, difficulties with interpretation of respiratory viral testing results include somewhat poor diagnostic test characteristics for some tests, uncertainty regarding true positives and causation of illness, delay in receiving the test result, and the incidence of concurrent bacterial infections or the presence of multiple viruses. We have given some examples of clinical scenarios where respiratory viral testing results could be expected to contribute to more appropriate clinical management decisions. Conclusions and Relevance: It is not good enough to "do" just because we "can." We suggest that for many healthy immune-competent children presenting with typical viral respiratory tract symptoms, the diagnosis can be made clinically, and frontline clinicians should think critically before automatically requesting a somewhat uncomfortable, expensive respiratory viral test, the result of which may not contribute to the child's treatment.
[Mh] Termos MeSH primário: Técnicas de Laboratório Clínico/normas
Laboratórios Hospitalares/normas
Infecções por Vírus Respiratório Sincicial/diagnóstico
Infecções Respiratórias/diagnóstico
Infecções Respiratórias/virologia
Viroses/diagnóstico
[Mh] Termos MeSH secundário: Criança
Testes Diagnósticos de Rotina
Feminino
Seres Humanos
Masculino
Infecções Respiratórias/epidemiologia
Sensibilidade e Especificidade
Viroses/epidemiologia
Viroses/virologia
Vírus/isolamento & purificação
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170905
[Lr] Data última revisão:
170905
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170704
[St] Status:MEDLINE
[do] DOI:10.1001/jamapediatrics.2017.0786


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[PMID]:28593928
[Au] Autor:Watson ID; Oosterhuis WP; Jorgensen PE; Dikmen ZG; Siodmiak J; Jovicic S; Aakre KM; Palicka V; Kutt M; European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Patient Focused Laboratory Medicine
[Ad] Endereço:.
[Ti] Título:A survey of patients' views from eight European countries of interpretive support from Specialists in Laboratory Medicine.
[So] Source:Clin Chem Lab Med;55(10):1496-1500, 2017 Aug 28.
[Is] ISSN:1437-4331
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is increasing interest in direct patient engagement including receiving their laboratory medicine results. We previously established an appetite for Specialists in Laboratory Medicine to support patients in understanding results. The aim of this study was to establish whether patients agreed with such an approach, determined through surveying views in eight European countries. METHODS: A standardized five-question survey was administered across eight European countries to a total of 1084 individuals attending medical outpatient clinics, with 100 patients each in Poland, Serbia, Netherlands, Turkey and Czech Republic, 101 in Estonia, 116 in Denmark and 367 in Norway. The responses across countries were compared using the chi-square test (p<0.05). RESULTS: Patients wanting their results ranged from 50% to 94% (mean 65%) of those responding positively, a mean of 72% wanted additional information with their results; direct receipt was preferred over referral to a website. Specialists in Laboratory Medicine providing such information were acceptable to a mean of 62% of those respondents wishing their results; in countries where payment was possible, there was little interest in making additional payment for such a service. CONCLUSIONS: A clear proportion of patients are interested in receiving their laboratory medicine results, the majority with explanatory notes; a role for Specialists in Laboratory Medicine is acceptable and raises the potential for direct engagement by such specialists with patients offering a new paradigm for the provision of laboratory medicine activities.
[Mh] Termos MeSH primário: Laboratórios Hospitalares
Pacientes/psicologia
[Mh] Termos MeSH secundário: Europa (Continente)
Seres Humanos
Internet
Especialização
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170609
[St] Status:MEDLINE


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[PMID]:28497543
[Au] Autor:Ye YY; Zhao HJ; Fei Y; Wang W; He FL; Zhong K; Yuan S; Wang ZG
[Ad] Endereço:National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, National Center of Gerontology, Beijing Hospital, Beijing, China.
[Ti] Título:Critical values in hematology of 862 institutions in China.
[So] Source:Int J Lab Hematol;39(5):513-520, 2017 Oct.
[Is] ISSN:1751-553X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: A national survey on critical values in hematology of China laboratories was conducted to determine the current practice and assess the quality indicators so as to obtain a quality improvement. METHODS: Laboratories participating were asked to submit the general information, the practice of critical value reporting, and the status of timeliness of critical value reporting. RESULTS: A total of 862 laboratories submitted the results. The majority of participants have included white blood cell count, blood platelet count, hemoglobin, prothrombin time, and activated partial thromboplastin time in their critical value lists. Many sources are used for establishing a critical value policy, and some of the laboratories consult with clinicians. The unreported critical value rate, late critical value reporting rate, and clinically unacknowledged rate in China are relatively low, and the median of critical value reporting time is 8-9 minutes. CONCLUSION: There exists a wide variety for critical value reporting in hematology in China. Laboratories should establish a policy of critical value reporting suited for their own situations and consult with clinicians to set critical value lists. Critical values are generally reported in a timely manner in China, but some measures should be taken to further improve the timeliness of critical value reporting.
[Mh] Termos MeSH primário: Hematologia/normas
Laboratórios Hospitalares/normas
[Mh] Termos MeSH secundário: Assistência Ambulatorial
China
Serviços Médicos de Emergência
Pesquisas sobre Serviços de Saúde
Testes Hematológicos/métodos
Testes Hematológicos/normas
Seres Humanos
Pacientes Internados
Melhoria de Qualidade
Indicadores de Qualidade em Assistência à Saúde
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170513
[St] Status:MEDLINE
[do] DOI:10.1111/ijlh.12681


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[PMID]:28477952
[Au] Autor:Gavala A; Myrianthefs P
[Ad] Endereço:National and Kapodistrian University of Athens, School of Health Sciences, Department of Nursing, "Agioi Anargyroi" General Hospital, Noufaron & Timiou Stavrou, Nea Kifissia, 14564, Athens, Greece.
[Ti] Título:Comparison of point-of-care versus central laboratory measurement of hematocrit, hemoglobin, and electrolyte concentrations.
[So] Source:Heart Lung;46(4):246-250, 2017 Jul - Aug.
[Is] ISSN:1527-3288
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: We aimed to investigate the accuracy of certain laboratory examinations obtained by the ABG analyzer (ROCHE AVL OMNI S) as compared to hospital central laboratory (CL). METHODS: We prospectively collected data obtained from the same arterial blood sample regarding hematocrit, hemoglobin, potassium, and sodium. RESULTS: ABG analyzer results were significantly lower (p < 0.0001) compared to CL values thus values between the two methods are not interchangeable. The mean bias for Hb, Na and K were within accepted by US Clinical Laboratory Improvement Amendment (USCLIA) differences (cut-off points) but not for Ht. In 8.0%, 17.5%, 37.5% and 56.0% of Hb, Na , K and Ht measurements respectively and 29.75% in sum the differences were over the USCLIA accepted limits. ABG analyzer significantly underestimate the values of Hb, Ht, Na and K , compared to CL and almost 30% of all examined parameters were beyond USCLIA accepted biases. CONCLUSIONS: ABG analyzer significantly underestimates the values of Hb, Ht, Na and K compared to CL and almost 30% for all examined parameters are beyond USCLIA accepted biases. These data do not support widespread or even careful use of POCT for making diagnostic and treatment decisions until technology improves and results in improved outcomes.
[Mh] Termos MeSH primário: Eletrólitos/análise
Hematócrito
Testes Hematológicos/métodos
Hemoglobinas/análise
Laboratórios Hospitalares/normas
Sistemas Automatizados de Assistência Junto ao Leito/normas
[Mh] Termos MeSH secundário: Idoso
Serviços Médicos de Emergência
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Electrolytes); 0 (Hemoglobins)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170508
[St] Status:MEDLINE


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[PMID]:28447421
[Au] Autor:Jackups R; Szymanski JJ; Persaud SP
[Ad] Endereço:Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
[Ti] Título:Clinical decision support for hematology laboratory test utilization.
[So] Source:Int J Lab Hematol;39 Suppl 1:128-135, 2017 May.
[Is] ISSN:1751-553X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Clinical decision support (CDS) is the use of information and communication technologies to improve clinical decision making and patient care. CDS applications have been used in many aspects of health care, including medication ordering and diagnostic prediction algorithms. As economic and regulatory pressures place a strain on laboratory resources, the potential of CDS to improve utilization of laboratory testing has also begun to be realized. Hematology and coagulation laboratories stand to gain tremendously from the implementation of CDS interventions, given their mixture of high-volume, low-cost tests (eg CBC, PT, aPTT) and tests that carry a high potential of being misused or misinterpreted (eg lupus anticoagulant, erythrocyte sedimentation rate, heparin-induced thrombocytopenia testing). This brief review will define the key terms in the field of clinical decision support, provide instructive examples of CDS interventions to improve utilization of hematology and coagulation testing, introduce methods to implement these interventions effectively, and discuss metrics by which the success of these interventions can be evaluated.
[Mh] Termos MeSH primário: Tomada de Decisões
Doenças Hematológicas
Testes Hematológicos
Laboratórios Hospitalares
[Mh] Termos MeSH secundário: Custos e Análise de Custo
Doenças Hematológicas/sangue
Doenças Hematológicas/diagnóstico
Doenças Hematológicas/economia
Testes Hematológicos/economia
Testes Hematológicos/métodos
Testes Hematológicos/normas
Seres Humanos
Laboratórios Hospitalares/economia
Laboratórios Hospitalares/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170612
[Lr] Data última revisão:
170612
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1111/ijlh.12679


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[PMID]:28430829
[Au] Autor:Sedrak MS; Myers JS; Small DS; Nachamkin I; Ziemba JB; Murray D; Kurtzman GW; Zhu J; Wang W; Mincarelli D; Danoski D; Wells BP; Berns JS; Brennan PJ; Hanson CW; Dine CJ; Patel MS
[Ad] Endereço:City of Hope Comprehensive Cancer Center, Duarte, California.
[Ti] Título:Effect of a Price Transparency Intervention in the Electronic Health Record on Clinician Ordering of Inpatient Laboratory Tests: The PRICE Randomized Clinical Trial.
[So] Source:JAMA Intern Med;177(7):939-945, 2017 Jul 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Many health systems are considering increasing price transparency at the time of order entry. However, evidence of its impact on clinician ordering behavior is inconsistent and limited to single-site evaluations of shorter duration. Objective: To test the effect of displaying Medicare allowable fees for inpatient laboratory tests on clinician ordering behavior over 1 year. Design, Setting, and Participants: The Pragmatic Randomized Introduction of Cost data through the electronic health record (PRICE) trial was a randomized clinical trial comparing a 1-year intervention to a 1-year preintervention period, and adjusting for time trends and patient characteristics. The trial took place at 3 hospitals in Philadelphia between April 2014 and April 2016 and included 98 529 patients comprising 142 921 hospital admissions. Interventions: Inpatient laboratory test groups were randomly assigned to display Medicare allowable fees (30 in intervention) or not (30 in control) in the electronic health record. Main Outcomes and Measures: Primary outcome was the number of tests ordered per patient-day. Secondary outcomes were tests performed per patient-day and Medicare associated fees. Results: The sample included 142 921 hospital admissions representing patients who were 51.9% white (74 165), 38.9% black (55 526), and 56.9% female (81 291) with a mean (SD) age of 54.7 (19.0) years. Preintervention trends of order rates among the intervention and control groups were similar. In adjusted analyses of the intervention group compared with the control group over time, there were no significant changes in overall test ordering behavior (0.05 tests ordered per patient-day; 95% CI, -0.002 to 0.09; P = .06) or associated fees ($0.24 per patient-day; 95% CI, -$0.42 to $0.91; P = .47). Exploratory subset analyses found small but significant differences in tests ordered per patient-day based on patient intensive care unit (ICU) stay (patients with ICU stay: -0.16; 95% CI, -0.31 to -0.01; P = .04; patients without ICU stay: 0.13; 95% CI, 0.08-0.17; P < .001) and the magnitude of associated fees (top quartile of tests based on fee value: -0.01; 95% CI, -0.02 to -0.01; P = .04; bottom quartile: 0.03; 95% CI, 0.002-0.06; P = .04). Adjusted analyses of tests that were performed found a small but significant overall increase in the intervention group relative to the control group over time (0.08 tests performed per patient day, 95% CI, 0.03-0.12; P < .001). Conclusions and Relevance: Displaying Medicare allowable fees for inpatient laboratory tests did not lead to a significant change in overall clinician ordering behavior or associated fees. Trial Registration: clinicaltrials.gov Identifier: NCT02355496.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Tomada de Decisão Clínica/métodos
Técnicas de Laboratório Clínico
Padrões de Prática Médica
[Mh] Termos MeSH secundário: Acesso à Informação
Adulto
Idoso
Técnicas de Laboratório Clínico/economia
Técnicas de Laboratório Clínico/métodos
Análise Custo-Benefício
Registros Eletrônicos de Saúde/estatística & dados numéricos
Feminino
Seres Humanos
Pacientes Internados
Laboratórios Hospitalares/economia
Masculino
Medicare
Meia-Idade
Padrões de Prática Médica/economia
Padrões de Prática Médica/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170824
[Lr] Data última revisão:
170824
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.1144



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