Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY.
Department of Neurology, University of Louisville, Louisville, KY.
J Appl Lab Med. 2021 Mar 1;6(2):387-396. doi: 10.1093/jalm/jfaa123.
For many laboratories, autoimmune encephalopathy (AE) panels are send-out tests. These tests are expensive, and ordering patterns vary greatly. There is also a lack of consensus on which panel to order and poor understanding of the clinical utility of these panels. These challenges were presented to our newly formed, multidisciplinary, diagnostic stewardship committee (DSC). Through this collaboration, we developed an algorithm for ordering AE panels; combining diagnostic criteria with practice guidelines.
We analyzed test-ordering patterns in 2018 and calculated a true-positive rate based on clinical presentation and panel interpretation. An evidence-based approach was combined with input from the Department of Neurology to synthesize our algorithm. Efficacy of the algorithm (number of panels ordered, cost, and true positives) was assessed before and after implementation.
In 2018, 77 AE-related panels were ordered, costing $137 510. The true-positive rate was 10%, although ordering multiple, similar panels for the same patient was common. Before implementing the algorithm (January 1-July 31, 2019), 55 panels were ordered, costing $105 120. The total true-positive rate was 3.6%. After implementation, 23 tests were ordered in a 5-month period, totaling $50 220. The true-positive rate was 13%.
With the DSC-directed mandate, we developed an algorithm for ordering AE panels. Comparison of pre- and postimplementation data showed a higher true-positive rate, indicating that our algorithm was able to successfully identify the at-risk population for AE disorders. This was met with a 43% decrease in the number of tests ordered, with total cost savings of $25 000 over 5 months.
对于许多实验室来说，自身免疫性脑病 (AE) 检测是送检项目。这些检测费用昂贵，且订购模式差异较大。此外，对于应该订购哪种检测，目前尚未达成共识，而且人们对这些检测的临床应用价值也缺乏了解。这些挑战被提交给我们新成立的多学科诊断管理委员会 (DSC)。通过这次合作，我们开发了一种用于订购 AE 检测的算法；将诊断标准与实践指南相结合。
我们分析了 2018 年的检测订购模式，并根据临床表现和检测解读计算了真阳性率。采用基于证据的方法，并结合神经病学系的意见，综合制定了我们的算法。在实施前后，评估了算法的效果（订购的检测数量、成本和真阳性率）。
2018 年，共订购了 77 项与 AE 相关的检测，费用为 137510 美元。真阳性率为 10%，尽管同一患者多次订购类似的多个检测很常见。在实施算法之前（2019 年 1 月 1 日至 7 月 31 日），共订购了 55 项检测，费用为 105120 美元。总真阳性率为 3.6%。实施后，在 5 个月内订购了 23 项检测，费用为 50220 美元。真阳性率为 13%。
在 DSC 的指导下，我们制定了用于订购 AE 检测的算法。实施前后数据的比较表明，真阳性率更高，这表明我们的算法能够成功识别出 AE 疾病的高危人群。这使得订购的检测数量减少了 43%，5 个月内共节省了 25000 美元的成本。
