Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records.

IF 2.3 4区 医学 Q3 BIOTECHNOLOGY & APPLIED MICROBIOLOGY
Massimo Gion, Roberto De Gobbi, Manuel Zorzi, Giovanni Carretta, Luca Leonardi, Stefano Guzzinati, Chiara Trevisiol, Maurizio Cancian, Giulia Cardinali, Federica Michieletto, Ruggero Dittadi, Aline S C Fabricio, Massimo Rugge, Francesca Russo
{"title":"Overordering of tumor marker for outpatients revealed by performance indicators and the impact of a health policy intervention: An observational study using administrative records.","authors":"Massimo Gion,&nbsp;Roberto De Gobbi,&nbsp;Manuel Zorzi,&nbsp;Giovanni Carretta,&nbsp;Luca Leonardi,&nbsp;Stefano Guzzinati,&nbsp;Chiara Trevisiol,&nbsp;Maurizio Cancian,&nbsp;Giulia Cardinali,&nbsp;Federica Michieletto,&nbsp;Ruggero Dittadi,&nbsp;Aline S C Fabricio,&nbsp;Massimo Rugge,&nbsp;Francesca Russo","doi":"10.1177/03936155231154663","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The overuse of laboratory tests contributes to impair health systems effectiveness, tumor markers (TMs) being a paradigmatic example. In the present study we applied indicators of TMs appropriateness developed from administrative datasets to appraise regionwide overordering in the clinical practice.</p><p><strong>Patients and methods: </strong>TMs ordered to outpatients in the Veneto Region over 6 years were obtained from the eletronic Outpatients' Records of Diagnostic and Therapeutic Procedures. TMs orders were examined as aggregated data or stratified according to disease codes, gender, age, and requests per patient. TMs recommended only for specific malignancies were examined using epidemiological data obtained from Veneto Tumor Registry.</p><p><strong>Results: </strong>A total of 5,821,251 TMs were ordered in 4,382,159 patients over 6 years. Overall, 3,252,389 (55.9%) TMs were ordered without appropriate disease codes (ranging from 77.0% for PSA to 17.5% for CA15.3). TM orders declined over 6 years (-13.4%), with a noticeable reduction of orders without appropriate disease codes (-21.3%). Orders decreased sharply from 2015 to 2016, after the enactment of a national Decree-Law aimed at improving appropriateness, and remained stable thereafter. However, the rate of inappropriate TMs requests still remained elevated (44.4%) in the last year of observation, with orders of TMs being much higher than expected on the basis of prevalence and incidence figures of specific malignancies.</p><p><strong>Conclusions: </strong>Indicators developed from administrative datasets were effective in assessing the overordering of TMs and the impact of interventions to improve appropriateness. The developed indicators could be considered for other diagnostic tests.</p>","PeriodicalId":50334,"journal":{"name":"International Journal of Biological Markers","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Biological Markers","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/03936155231154663","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"BIOTECHNOLOGY & APPLIED MICROBIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose: The overuse of laboratory tests contributes to impair health systems effectiveness, tumor markers (TMs) being a paradigmatic example. In the present study we applied indicators of TMs appropriateness developed from administrative datasets to appraise regionwide overordering in the clinical practice.

Patients and methods: TMs ordered to outpatients in the Veneto Region over 6 years were obtained from the eletronic Outpatients' Records of Diagnostic and Therapeutic Procedures. TMs orders were examined as aggregated data or stratified according to disease codes, gender, age, and requests per patient. TMs recommended only for specific malignancies were examined using epidemiological data obtained from Veneto Tumor Registry.

Results: A total of 5,821,251 TMs were ordered in 4,382,159 patients over 6 years. Overall, 3,252,389 (55.9%) TMs were ordered without appropriate disease codes (ranging from 77.0% for PSA to 17.5% for CA15.3). TM orders declined over 6 years (-13.4%), with a noticeable reduction of orders without appropriate disease codes (-21.3%). Orders decreased sharply from 2015 to 2016, after the enactment of a national Decree-Law aimed at improving appropriateness, and remained stable thereafter. However, the rate of inappropriate TMs requests still remained elevated (44.4%) in the last year of observation, with orders of TMs being much higher than expected on the basis of prevalence and incidence figures of specific malignancies.

Conclusions: Indicators developed from administrative datasets were effective in assessing the overordering of TMs and the impact of interventions to improve appropriateness. The developed indicators could be considered for other diagnostic tests.

绩效指标揭示的门诊患者肿瘤标志物的过度订购和卫生政策干预的影响:一项使用行政记录的观察性研究。
目的:过度使用实验室检测有助于损害卫生系统的有效性,肿瘤标志物(TMs)是一个典型的例子。在本研究中,我们应用从管理数据集开发的TMs适当性指标来评估临床实践中的区域性过度订购。患者和方法:从电子门诊诊断和治疗程序记录中获得6年来威尼托地区门诊患者的TMs。TMs订单作为汇总数据进行检查,或根据疾病代码、性别、年龄和每位患者的要求进行分层。使用威尼托肿瘤登记处获得的流行病学数据检查仅推荐用于特定恶性肿瘤的TMs。结果:在6年的时间里,4,382,159名患者共订购了5,821,251例TMs。总体而言,3252389例(55.9%)TMs订购时没有适当的疾病代码(从PSA的77.0%到CA15.3的17.5%)。TM订单在6年内下降(-13.4%),没有适当疾病代码的订单明显减少(-21.3%)。2015年至2016年,在国家颁布旨在提高适当性的法令法后,订单量急剧下降,此后保持稳定。然而,在最后一年的观察中,不适当的TMs请求率仍然很高(44.4%),TMs订单远远高于基于特定恶性肿瘤患病率和发病率数据的预期。结论:从管理数据集开发的指标有效地评估了TMs的过度订购和干预措施对提高适当性的影响。制定的指标可考虑用于其他诊断测试。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
International Journal of Biological Markers
International Journal of Biological Markers 医学-生物工程与应用微生物
CiteScore
4.10
自引率
0.00%
发文量
43
期刊介绍: IJBM is an international, online only, peer-reviewed Journal, which publishes original research and critical reviews primarily focused on cancer biomarkers. IJBM targets advanced topics regarding the application of biomarkers in oncology and is dedicated to solid tumors in adult subjects. The clinical scenarios of interests are screening and early diagnosis of cancer, prognostic assessment, prediction of the response to and monitoring of treatment.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信