How is your lab performing?

Transcription

1 ARUP UTILIZATION SUPPORT NETWORK Thyroid testing benchmarking study How is your lab performing? Number of hospitals Your hospital Ratio of total T3/TSH

2 Executive Summary ARUP is expanding its utilization management support by conducting benchmarking studies to help clients better understand how to utilize laboratory testing more effectively. This targeted benchmarking program offers clients valuable information that can be used to reduce costs and enhance outcomes by improving physicians test-ordering behavor. We invite you to participate in a benchmarking study on thyroid testing. This study will provide a comprehensive comparison of thyroid testing across our client network. Background ARUP is committed to helping our clients obtain the best value for their testing dollar. We have been a leader in utilization management since 1998 by offering support through our test-utilization report program. We are building on that success. Our clients often wish to know how they perform relative to peers in the ARUP network and what others are doing to manage test utilization. This benchmarking study will answer these questions: 1. How are we performing relative to our peers? 2. What techniques are being used by our peers to manage utilization? 3. What works, and can we identify best practices that are associated with good patient outcomes? ARUP UTILIZATION SUPPORT NETWORK ARUP LABORATORIES.

3 As the center of a large client network, ARUP is uniquely positioned to answer these questions. ARUP s network is a source of knowledge and helps clients gain value and insight. Our goal is to help our partners improve performance by facilitating collaborative studies between our partners in the network and offering a series of benchmarking studies as an added service to our clients. What is required of you: We will ask you to complete a web-survey focused on information related to thyroid testing volumes and managerial interventions related to thyroid testing. We will also collect data about your organization and form peer groups for valid comparisons. Confidentiality and publication of results: All data will be kept confidential. We will publish a report for participants, present a webinar to discuss the findings, and publish a summary of the findings in an academic journal. Participants in the survey will not be listed by name. We view this as a collaborative research project among members of the ARUP network and welcome the opportunity to engage in follow-up studies and publications with participants. ARUP UTILIZATION SUPPORT NETWORK DECEMBER

4 Study Details Study topic: Thyroid testing and management of thyroid testing utilization. Study rationale: We find that thyroid tests are often misordered. The usual workup for thyroid disease is the measurement of TSH and free T4. These two tests should lead to a diagnosis in the vast majority of cases. When uncertainty remains, a total T3 can be ordered to resolve the diagnosis. There are no guidelines to indicate the proper ratio of T3 testing to TSH and T4 testing. This study will determine the variation in thyroid testing patterns. Participants can use this information to gauge their performance relative to peers. Study report: All participants will receive a detailed benchmarking report. ARUP will also provide a webinar summarizing the results. The webinar will be presented by two medical directors, one who specializes in utilization and another who specializes in endocrinology. How to participate: You can participate by completing a simple survey. There are two ways to complete the survey: Website: We have a website that contains information about the study as well as a link to a web-survey where you can enter your data. Please visit: Paper form: To receive a paper form of the survey visit the study website at contact your business develoment manager, or contact Dr. Schmidt at robert.l.schmidt@aruplab.com. ARUP UTILIZATION SUPPORT NETWORK ARUP LABORATORIES.

5 Study Investigators Robert Schmidt MD, PhD, MBA (study leader) Dr. Schmidt is a medical director of informatics at ARUP Laboratories and an assistant professor of pathology at the University of Utah School of Medicine. He is the Director of the Center for Effective Medical Testing and Medical Director of the Clinical Laboratory at the Huntsman Cancer Hospital. Prior to completing medical school, Dr. Schmidt was an assistant professor of operations management at the Carlson School of Management at the University of Minnesota and an associate professor of clinical operations management at the Marshall School of Business at the University of Southern California. Dr. Schmidt s medical research focuses on diagnostic testing, specifically utilizing his business background to complement medical knowledge in performing evidence-based evaluation of diagnostic testing. His research includes comparative effectiveness, cost-effectiveness, and utilization analyses of diagnostic tests, as well as operations and technology management related to diagnostic testing. He is certified in clinical pathology by the American Board of Pathology. Joely Straseski PhD, MS, MT(ASCP), DABCC Dr. Straseski is a medical director of endocrinology at ARUP and an assistant professor of pathology at the University Of Utah School Of Medicine. She received her PhD in pathology and laboratory medicine and a master of science in bacteriology from the University of Wisconsin- Madison, where she also served as a postdoctoral associate in the Department of Pathology. Dr. Straseski completed a postdoctoral fellowship in clinical chemistry at the Johns Hopkins Medical Institutions in Baltimore, Maryland. She has previously been awarded the Past-Presidents Scholarship by the American Association for Clinical Chemistry, as well as a Distinguished Abstract Award from the National Academy of Clinical Biochemistry. Dr. Straseski is board certified in clinical chemistry by the American Board of Clinical Chemistry. ARUP UTILIZATION SUPPORT NETWORK DECEMBER

6 Example Benchmarking Report We will conduct a range of benchmarking analyses on thyroid testing using data on testing volumes for TSH, total T3, free T3, total T4, free T4, reverse T3, and T3 uptake. A benchmarking profile for each test similar to the one shown below will be provided. Example data: ratio of testing volumes for total T3 to TSH. Physicians typically diagnose thyroid disease using only TSH and free T4. Occasionally, total T3 can be helpful. ARUP has found a considerable variation in the rate of total T3 testing and finds it useful to compare the ratio of total T3 testing volume to TSH testing volume across hospitals. Number of hospitals Your hospital Ratio of total T3/TSH This graph illustrates a hypothetical distribution of total T3 to TSH testing by hospital. Although no specific guidelines for this ratio exist, clients can review what is typical and how their testing pattern compares to peers. High levels of this ratio represent potential overutilization of T3 testing. We will provide similar analyses for TSH, total T3, free T3, total T4, free T4, reverse T3, and T3 uptake. The data will highlight possible opportunities to improve test utilization and reduce unnecessary testing. ARUP UTILIZATION SUPPORT NETWORK ARUP LABORATORIES.

7 Thyroid Benchmarking Study There are two ways to actively participate in the thyroid testing benchmarking study: Website: We have a website that contains information about the study and a link to a web survey where you can enter your data. Please visit: Paper form: To receive a paper form of the survey, visit the study website at www. aruplab.com/thyroid-testing, contact your business develoment manager, or contact Dr. Schmidt at robert.l.schmidt@aruplab.com. The form is also included below; please scan this form and send it to robert.l.schmidt@aruplab.com or return it to your business development manager. Part A: Contact information Before starting the survey, please provide your contact information in case ARUP needs to clarify any of your responses. Be assured that your responses will remain anonymous. Name: Title: Phone: Organization: Facility: Part B: Thyroid testing volumes for 2015 Please list the total testing volume (both in-house and send-out) for the following tests for the year If possible, determine the inpatient and outpatient volumes separately. TSH Free T4 Total T4 Free T3 Total T3 Reverse T3 T3 uptake Complete blood count (CBC) Inpatient Outpatient Total DECEMBER

8 Part C: Utilization management A variety of methods can be used to manage test utilization. Please indicate which methods have ever been used by your organization to manage test utilization at your facility. Interventions to improve thyroid testing utilization Providing information Education: providing information regarding appropriate test utilization Private profiling: providing feedback to individual physicians regarding their testing usage relative to other physicians Public profiling: making provider-level test usage data public Providing cost information on test-request forms and order menus Electronic decision support: providing testing guidelines on order systems Menu modification Removing obsolete tests from forms and test menus Order restrictions Canceling duplicate tests Restricting tests to specialists Requiring approval from a pathologist or specialist Other (specify) Has been used at our facility Effectiveness: 1 = not effective 5 = effective NA = not applicable Does your laboratory have personnel on call (e.g., pathologist, resident) to consult on testutilization questions? Does your organization collect information on test-ordering practices to improve utilization? ARUP LABORATORIES.

9 If yes, what information do you collect on test-ordering practices to improve utilization? Please select all that apply. ordering location (ED, intensive care, clinics) ordering service (endocrinology, surgery) provider (physician, midlevel) other (specify) Does your organization have a test-utilization committee? If yes, has the utilization committee ever addressed thyroid testing? Has your organization ever issued guidelines for thyroid testing? Does your organization have an endocrinology department? If yes, has your endocrinology department been involved in utilization management? Has the endocrinology department provided guidelines for thyroid testing to primary care providers? Has your organization appointed a person to manage utilization issues? If yes, approximately how many FTEs are devoted to utilization? one more than three two don t know three If yes, what is the job title of the utilization person? Does your organization have a computerized physician order entry (CPOE) system for tests? If yes, is the CPOE available at all locations? DECEMBER

10 Please respond to the following statement: It is easy for me to obtain the following testing information. Query type Strongly disagree Disagree Neutral Agree Strongly agree Number of tests performed in my laboratory Number of a particular test performed by all providers Number of a particular test performed by location Part D: organization description What is the staffed bed size of your organization? more than don t know In which state/district is your facility located? Please describe the location of your institution: city/urban federal installation laboratory suburban other (specify) rural Please list your Institution type: Nongovernmental voluntary, nonprofit hospital proprietary hospital private university hospital children s hospital system/integrated delivery network group practice reference laboratory other nongovernmental (specify) Governmental (nonfederal) state hospital city hospital county hospital public university hospital other governmental, nonfederal (specify) Governmental (federal) veterans hospital Department of Defense Indian Health Service other governmental, federal (specify) other governmental, nonfederal (specify) ARUP would like to match your performance to similar peers. Please indicate which of the following features should be used to match you with peers by selecting all that apply. Range of hospital services: emergency room level trauma center transplant center newborn ICU size: institutuion type: location: other (specify): ARUP LABORATORIES.

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12 A nonprofit enterprise of the University of Utah and its Department of Pathology ARUP LABORATORIES 500 Chipeta Way Salt Lake City, UT Phone: (800) Fax: (801) December ARUP Laboratories