Ziemba Yonah C, Lomsadze Liya, Jacobs Yehuda, Chang Tylis Y, Haghi Nina
Department of Pathology and Laboratory Medicine, Northwell Health, Lake Success, NY, USA.
J Pathol Inform. 2018 Sep 27;9:31. doi: 10.4103/jpi.jpi_7_18. eCollection 2018.
When a provider orders a test in a pattern that is substantially different than their peers, it may indicate confusion in the test name or inappropriate use of the test, which can be elucidated by initiating dialog between clinicians and the laboratory. However, the analysis of ordering patterns can be challenging. We propose a utilization index (UI) as a means to quantify utilization patterns for individual providers and demonstrate the use of heatmaps to identify opportunities for improvement.
Laboratory test orders by all providers were extracted from the laboratory information system. Providers were grouped into cohorts based on the specialty and patient population. A UI was calculated for each provider's use of each test using the following formula: (UI = [provider volume of specific test/provider volume of all tests]/[cohort volume of specific test/cohort volume of all tests]). A heatmap was generated to compare each provider to their cohort.
This method identified several hot spots and was helpful in reducing confusion and overutilization.
The UI is a useful measure of test ordering behavior, and heatmaps provide a clear visual illustration of the utilization indices. This information can be used to identify areas for improvement and initiate meaningful dialog with providers, which will ultimately bring improvement and reduction in costs. Our method is simple and uses resources that are widely available, making this method effective convenient for many other laboratories.
当医疗服务提供者的检查申请模式与同行存在显著差异时，这可能表明其对检查名称存在混淆或对检查的使用不当，而通过临床医生与实验室之间展开对话可对此加以阐明。然而，对申请模式进行分析可能具有挑战性。我们提出一种利用指数（UI）作为量化个体医疗服务提供者使用模式的一种手段，并展示如何使用热图来识别改进机会。
从实验室信息系统中提取所有医疗服务提供者的实验室检查申请。根据专业和患者群体将医疗服务提供者分组。使用以下公式为每个医疗服务提供者对每项检查的使用情况计算一个利用指数：（利用指数 = [特定检查的提供者申请量/所有检查的提供者申请量]/[特定检查的队列申请量/所有检查的队列申请量]）。生成热图以将每个医疗服务提供者与其所在队列进行比较。
该方法识别出了几个热点，有助于减少混淆和过度使用。
利用指数是检查申请行为的一项有用指标，热图能清晰直观地展示利用指数。这些信息可用于识别改进领域，并与医疗服务提供者展开有意义的对话，这最终将带来改进并降低成本。我们的方法简单，且使用的是广泛可用的资源，使得该方法对许多其他实验室而言有效且便捷。
