Seegmiller Adam C, Kim Annette S, Mosse Claudio A, Shaver Aaron C, Thompson Mary Ann, Li Shaoying, Head David R, Zutter Mary M
Am J Clin Pathol. 2016 Nov 1;146(5):585-593. doi: 10.1093/ajcp/aqw180.
To determine the effect of iterative refinement of standard ordering protocols on test utilization and results for bone marrow biopsy specimens.
Eighteen months of test utilization and result data were used to revise the protocols that determine cytogenetic and molecular test selection on bone marrow specimens and then compared with data obtained following protocol revision.
Revision of protocols resulted in reduction in total tests and associated charges, due to a decrease in tests both concordant and discordant with the protocols. These reductions only occurred in diseases for which revisions were made and were limited to cases in which reflex testing was performed. There was an increase in the fraction of positive tests, which was also limited to reflex testing.
Data-driven iterative revision of protocols further improves test utilization and performance, while reducing cost. Analysis of testing data can be used to continuously improve test ordering decisions.
确定标准医嘱协议的迭代优化对骨髓活检标本检测利用情况和结果的影响。
利用18个月的检测利用情况和结果数据来修订确定骨髓标本细胞遗传学和分子检测选择的协议，然后与协议修订后获得的数据进行比较。
协议修订导致总检测次数和相关费用减少，这是由于与协议一致和不一致的检测次数均有所减少。这些减少仅发生在进行了修订的疾病中，并且仅限于进行了反射性检测的病例。阳性检测的比例有所增加，这也仅限于反射性检测。
基于数据驱动的协议迭代修订可进一步提高检测利用情况和性能，同时降低成本。检测数据分析可用于持续改进检测医嘱决策。
