Analysis of current thyroid function test ordering practices

被引:19
|
作者
Kluesner, Joseph K. [1 ,3 ]
Beckman, Darrick J. [1 ,3 ]
Tate, Joshua M. [1 ,3 ]
Beauvais, Alexis A. [1 ,3 ]
Kravchenko, Maria I. [1 ,3 ]
Wardian, Jana L. [2 ,3 ]
Graybill, Sky D. [1 ,3 ]
Colburn, Jeffrey A. [1 ,3 ]
Folaron, Irene [1 ,3 ]
True, Mark W. [1 ,3 ]
机构
[1] San Antonio Mil Med Ctr, Serv Endocrinol, 3551 Roger Brooke Dr, San Antonio, TX 78234 USA
[2] Wilford Hall Ambulatory Surg Ctr, Diabet Ctr Excellence, San Antonio, TX USA
[3] Uniformed Serv Univ Hlth Sci, Bethesda, MD USA
关键词
laboratory utilization; resource stewardship; thyroid function test; PRIMARY-CARE; ASSOCIATION GUIDELINES; THYROTROPIN; COSTS; HYPOTHYROIDISM; THYROTOXICOSIS; DYSFUNCTION; EXPERIENCE; DIAGNOSIS; BENEFITS;
D O I
10.1111/jep.12846
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
RationaleCurrent guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease. ObjectiveTo evaluate our institution's practice in ordering thyroid function tests (TFTs) and to identify strategies to reduce inappropriate FT4 and FT3 testing. MethodsA record of all TFTs obtained in the San Antonio Military Health System during a 3-month period was extracted from the electronic medical record. The TFTs of interest were TSH, FT4, thyroid panel (TSH+FT4), FT3, total thyroxine (T4), and total triiodothyronine (T3). These were categorized based on the presence or absence of hypothyroidism. ResultsBetween August 1 and October 31, 2016, there were 38 214 individual TFTs ordered via 28597 total laboratory requests; 11486 of these requests were in patients with a history of hypothyroidism. The number (percent) of laboratory requests fell into these patterns: TSH alone 14919 (52.14%), TSH+FT4 7641 (26.72%), FT3 alone 3039 (10.63%), FT4 alone 1219 (4.26%), TSH+FT4+FT3 783 (2.74%), and others 996 (3.48%); 36.0% of TFTs ordered were free thyroid hormones. Projected out to a year, using Department of Defense laboratory costs, $317429 worth of TFTs would be ordered, with free thyroid hormone testing accounting for $107720. ConclusionInappropriate ordering of free thyroid hormone tests is common. In an era of rising healthcare costs, inappropriate thyroid function testing is an ideal target for efforts to reduce laboratory overutilization, which in our system, could save up to $120000 per year. Further evaluation is needed to determine strategies that can reduce excessive thyroid hormone testing.
引用
收藏
页码:347 / 352
页数:6
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