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Chapter 44 : Controlling Test Utilization and Relevancy

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Abstract:

This chapter provides a strategy for making changes in laboratory utilization that are based on the clinical relevance of the tests. Although this chapter covers clinical laboratory management in general, the information that has been selected for this chapter deals primarily with clinical microbiology. The published data regarding appropriate laboratory utilization has, until recently, focused on the issues of the relative accuracy of diagnostic methods, clinical relevance of tests, or the cost-effectiveness of different diagnostic methods. Many changes that are needed to make a laboratory more cost-effective or clinically relevant are contentious, even when they are not costly. There are several reasons for this. First is that making changes can mean taking something away from providers, and it is axiomatic that it is more difficult to take something away than it is to not give it in the first place. Second reason is that making changes shifts control from the provider to the laboratory, and providers may perceive that this affects their clinical autonomy and/or their ability to act on behalf of their patients. Finally, making changes is difficult under most circumstances, even when it is perceived to be in one's best interests. The published data about changing physician behavior indicate that most approaches achieve only a temporary effect or are ineffective altogether. Of the described methods that have been shown to be effective, use of laboratory information systems (LIS)-based controls may be one of the more effective methods.

Citation: Wilson M, Procop G, Reller L. 2004. Controlling Test Utilization and Relevancy, p 744-754. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch44

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References

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Tables

Generic image for table
Table 44.1

Characteristics of clinically relevant laboratory tests

Citation: Wilson M, Procop G, Reller L. 2004. Controlling Test Utilization and Relevancy, p 744-754. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch44
Generic image for table
Table 44.2

Laboratory-based approaches to control

Citation: Wilson M, Procop G, Reller L. 2004. Controlling Test Utilization and Relevancy, p 744-754. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch44
Generic image for table
Table 44.3

Institutional-based approaches to control

Citation: Wilson M, Procop G, Reller L. 2004. Controlling Test Utilization and Relevancy, p 744-754. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch44
Generic image for table
Table 44.4

Implementation of diagnostic microbiology policies

Modified from reference .

Citation: Wilson M, Procop G, Reller L. 2004. Controlling Test Utilization and Relevancy, p 744-754. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch44

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