Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA.
Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA.
J Thromb Thrombolysis. 2020 Jan;49(1):108-112. doi: 10.1007/s11239-019-01930-w.
Thrombophilia testing is rarely recommended in acute care settings due to the high likelihood of false-positive and false-negative results. Inappropriately performing these tests in the acute care setting is associated with inaccurate interpretation and an increased economic burden. In this retrospective analysis, the appropriateness of thrombophilia tests ordered for patients in an acute care setting was evaluated in terms of both clinical utility and economic costs. This analysis included adult inpatients discharged from an academic community medical center from November 1, 2016 to November 1, 2017 who received thrombophilia testing. Patients were stratified into two groups: appropriately tested and inappropriately tested based on data abstracted directly from the electronic health record. The primary outcome, the appropriateness of the tests, was based on published criteria for thrombophilia testing and included concurrent anticoagulation use, patient admitting diagnosis, and/or comorbidities associated with thrombosis risk. The secondary endpoint was the financial burden of inappropriate thrombophilia testing based on assay charges. The analytic sample included 200 patients and 1393 thrombophilia tests. In 179 patients (89.5%), 1168 tests (83.8%) were inappropriately conducted. From 179 patients, tests in 85 were inappropriate due to concurrent anticoagulant use and/or provoked venous thromboembolism (VTE), and tests in 94 were inappropriate due to a lack of 2 or more risk factors for thrombophilia. Only 21 patients (10.5%) had appropriate testing with 225 tests (16.2%). The financial impact of inappropriate testing was estimated as excess charges amounting to $148,151.16/year. Restricting testing to avoid unnecessary risks and costs warrants further analysis.
由于假阳性和假阴性结果的可能性很高，血栓形成倾向检测在急性护理环境中很少被推荐。在急性护理环境中不恰当地进行这些测试与不准确的解释和增加的经济负担有关。在这项回顾性分析中，根据临床实用性和经济成本评估了在急性护理环境中为患者开血栓形成倾向测试的适当性。该分析包括 2016 年 11 月 1 日至 2017 年 11 月 1 日从学术社区医疗中心出院的成年住院患者，他们接受了血栓形成倾向测试。患者分为两组：根据从电子健康记录中直接提取的数据，适当测试和不适当测试。主要结果，即测试的适当性，基于血栓形成倾向测试的发布标准，包括同时使用抗凝剂、患者入院诊断和/或与血栓形成风险相关的合并症。次要终点是基于检测费用的不适当血栓形成倾向检测的财务负担。分析样本包括 200 名患者和 1393 项血栓形成倾向检测。在 179 名患者（89.5%）中，1168 项测试（83.8%）的检测不适当。在 179 名患者中，由于同时使用抗凝剂和/或引发静脉血栓栓塞（VTE），85 项测试不适当，由于缺乏 2 个或更多血栓形成倾向危险因素，94 项测试不适当。只有 21 名患者（10.5%）进行了适当的测试，共进行了 225 项测试（16.2%）。不适当测试的财务影响估计为多余费用为每年 148151.16 美元。限制检测以避免不必要的风险和成本值得进一步分析。
