意大利一家临床实验室采用促甲状腺激素反射算法。

Adoption of TSH Reflex algorithm in an Italian clinical laboratory.

作者信息

Caldarelli G, Troiano G, Rosadini D, Nante N

机构信息

Laboratory Medicine Functional Area, "Misericordia" Hospital of Grosseto, Italy.

Post Graduate School of Public Health, University of Siena, Italy.

出版信息

Ann Ig. 2017 Jul-Aug;29(4):317-322. doi: 10.7416/ai.2017.2158.

DOI:10.7416/ai.2017.2158

PMID:28569340

Abstract

BACKGROUND

TSH Reflex is an automated diagnostic algorithm which follows the rule "If ... then", in which the initial determination of TSH is followed by the determination of fT4, and possibly of fT3, if TSH is not within the reference limits. The aim of our study was to evaluate the results of the introduction and implementation of the test "TSH Reflex", which started in late 2013 in the hospital of Grosseto, comparing the requests of thyroid hormones for external patients, in 2012, 2014 and 2015.

METHODS

In our study we analyzed the number of thyroid tests prescribed in 2012, 2014 and 2015 and we calculated the increase in prescription of "TSH Reflex" from 2014 to 2015; the prescriptive appropriateness, after the introduction of the "TSH Reflex", through the ratios TSH/FT4, TSH/FT3 and the ratio "TSH Reflex"/TSH. Finally we calculated the total spending for the reagents in 2012, 2014 and 2015 and the consequent savings in euros (the costs of the reagents did not change during that time).

RESULTS

Requests for TSH decreased by 4.6% in 2014, compared to 2012 and by 5.4% in 2015 compared to 2014, with a 9.8% reduction in 2015 compared to 2012. The requests for FT4 decreased by 11.5%, comparing 2014 with 2012, by 5.3% comparing 2015 with 2014, with a 16.2% reduction in 2015 compared to 2012. The requests for FT3 decreased by 13.3% in 2014 compared to 2012 and by 8.4% in 2015 compared to 2014, with a 20.6% reduction in 2015 compared to 2012. The appropriateness, evaluated the indicator TSH/FT4, increased by 7.6%, comparing 2014 with 2012, and remained unchanged in 2015. In 2012 71,134 euros were spent, 63,998 euros in 2014, 60,055 euros in 2015, resulting in a saving of € 11,079 in 2015 compared to 2012. The spending for "TSH Reflex" should be subtracted (1,964 Euros in 2015) from the previous savings.

CONCLUSIONS

The improvement of the efficiency and the prescriptive appropriateness was better in 2014, the first year of implementation of the "TSH Reflex". The overall assessment suggests that the 2014 results are attributable to the letters that general practitioners received in December 2013, with a temporary increase of the use of the test. We need further analyses with the same indicators in order to assess the possibility of additional improvements in the future.

摘要

背景

促甲状腺激素反射（TSH Reflex）是一种遵循“如果……那么”规则的自动化诊断算法，即首先测定促甲状腺激素（TSH），若TSH不在参考范围内，则随后测定游离甲状腺素（fT4），可能还会测定游离三碘甲状腺原氨酸（fT3）。我们研究的目的是评估2013年末在格罗塞托医院开始引入并实施的“TSH Reflex”检测的结果，比较2012年、2014年和2015年外部患者甲状腺激素的检测需求。

方法

在我们的研究中，我们分析了2012年、2014年和2015年所开具的甲状腺检测数量，并计算了2014年至2015年“TSH Reflex”检测开具量的增长；在引入“TSH Reflex”后，通过TSH/fT4、TSH/fT3比值以及“TSH Reflex”/TSH比值评估处方的合理性。最后，我们计算了2012年、2014年和2015年试剂的总花费以及相应的欧元节省金额（在此期间试剂成本未变）。

结果

与2012年相比，2014年TSH检测需求下降了4.6%，与2014年相比，2015年下降了5.4%，2015年与2012年相比下降了9.8%。与2012年相比，2014年fT4检测需求下降了11.5%，与2014年相比，2015年下降了5.3%，2015年与2012年相比下降了16.2%。与2012年相比，2014年fT3检测需求下降了13.3%，与2014年相比，2015年下降了8.4%，2015年与2012年相比下降了20.6%。通过TSH/fT4指标评估的合理性，与2012年相比，2014年提高了7.6%，2015年保持不变。2012年花费71,134欧元，2014年花费63,998欧元，2015年花费60,055欧元，2015年与2012年相比节省了11,079欧元。之前节省的金额应减去“TSH Reflex”的花费（2015年为1,964欧元）。