Efforts to cut unnecessary blood testing bring major decreases in health care spending

July 1, 2014

Researchers at Johns Hopkins Bayview Medical Center used two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain and to achieve a large decrease in patient charges.

The team provided information and education to physicians about proven testing guidelines and made changes to the computerized provider order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for so-called cardiac biomarkers. A year after implementation, the guidelines saved the medical center an estimated $1.25 million in laboratory charges.

In this case, part of the focus was on tests to assess levels of troponin, a protein whose components increase in the blood when heart muscle is damaged. Frequently, troponin tests are repeated four or more times in a 24-hour period, which studies have suggested is excessive, and they are often done along with tests for other biomarkers that are redundant.

In a report published June 28 in the Journal of General Internal Medicine, the research team describes how these interventions reduced overuse of troponin and other biomarker testing without compromising patient care. If adopted widely, the team says, cost savings could be substantial.

"This study has broader implications for the system, as most hospitals continue to redundantly test people for and other symptoms," says report author Jeffrey C. Trost, M.D., an assistant professor of medicine, director of the cardiac catheterization laboratory and co-director of interventional cardiology at Johns Hopkins Bayview Medical Center. "Implementing our interventions could save patients and society a significant amount of money, potentially several billion dollars."

For the study, the Johns Hopkins team set out to lower the rate at which doctors order cardiac biomarker testing for the diagnosis of by basing the desired rate on scientific evidence.

In 2010, the researchers report, more than 17 million patients with chest pain visiting an emergency department in the United States received cardiac biomarker testing.

Between August and October 2011 at Johns Hopkins Bayview Medical Center, the team introduced written institutional guideline and changes to the computerized provider order entry system designed to reduce redundant testing.

The new guidelines suggest ordering troponin alone, without creatine kinase or creatine kinase-MB, for patients suspected to have acute coronary syndrome. It specifies that troponin should be assessed no more than three times over 18 to 24 hours.

Internists and emergency department doctors attended informational sessions to learn the guidelines, and all received quick reference cards summarizing them.

In the computerized provider order entry system, orders for creatine kinase and creatine kinase-MB were removed from all standardized order sets. Troponin orders were removed from all order sets, except two that are used for evaluating new acute coronary syndrome symptoms. A pop-up warning alerted providers when a troponin test was ordered sooner than six hours after a previous one, or when a provider attempted to order creatine kinase or creatine kinase-MB at the same time.

Twelve months after the interventions, doctors' use of the new guidelines increased from 57.1 percent to 95.5 percent and led to a 66 percent decrease in the absolute number of tests ordered. Also, there was a small but statistically significant increase in the primary or secondary diagnosis of acute coronary syndrome after the intervention period.

Lead author Marc R. Larochelle, M.D., an internal medicine resident at Johns Hopkins Bayview Medical Center during the study and now a fellow in general medicine at Harvard Medical School, says that, "Through review of available evidence and reflection on our own practice, I believe we can proactively identify many practices that may be unnecessary and wasteful. We have demonstrated proof of concept that doctors can be leaders in delivering improved value for our patients and health care systems."

Larochelle and Trost believe that provider education and changes to the ordering system were effective in aligning physician ordering behavior with evidence-based guidelines and reducing wasteful health care spending.

The full report is titled "Reducing Excess Cardiac Biomarker Testing at an Academic Medical Center."

Explore further: Blood test helps predict heart attack risk for patients with chest pain

Related Stories

Blood test helps predict heart attack risk for patients with chest pain

March 31, 2014
Patients presenting to the emergency department with an undetectable level of the blood biomarker high-sensitivity cardiac troponin T, and whose ECGs show no sign of restricted blood flow, have a minimal risk of heart attack ...

Biomarker assessment in suspected ACS could be practice-changing: BIC-8 results

September 3, 2013
An emergency department strategy that uses two biomarkers to triage patients with suspected acute coronary syndrome (ACS) can increase the rate of early, safe hospital discharge, according to results of the Biomarkers in ...

Lab monitoring tests not always ordered per recommendations

June 26, 2014
Why does one physician in a walk-in practice order laboratory monitoring tests for patients more often than a colleague working down the hallway? Which factors influence the use of these important tests that can help doctors ...

New test set to improve care for patients with suspected heart attack

May 2, 2014
Manchester researchers have developed a novel approach, called the Manchester Acute Coronary Syndromes Decision Rule, to more quickly and effectively diagnose heart attack in patients admitted to emergency departments.

Study assesses use of fingerstick blood sample with i-STAT point-of-care device

September 23, 2013
Researchers have determined that fingerstick cardiac troponin I assay testing using thepoint-of-care i-STAT device is not accurate enough to determine the exact troponin level without the application of a corrective term.

New blood test could detect heart attacks more quickly

February 25, 2014
A new blood test can detect heart attacks hours faster than the current gold-standard blood test, according to a study led by Loyola University Chicago Stritch School of Medicine researchers.

Recommended for you

Expert: Be concerned about how apps collect, share health data

October 20, 2017
As of 2016 there were more than 165,000 health and wellness apps available though the Apple App Store alone. According to Rice University medical media expert Kirsten Ostherr, the Food and Drug Administration (FDA) regulates ...

More teens than ever aren't getting enough sleep

October 19, 2017
If you're a young person who can't seem to get enough sleep, you're not alone: A new study led by San Diego State University Professor of Psychology Jean Twenge finds that adolescents today are sleeping fewer hours per night ...

Across Asia, liver cancer is linked to herbal remedies: study

October 18, 2017
Researchers have uncovered widespread evidence of a link between traditional Chinese herbal remedies and liver cancer across Asia, a study said Wednesday.

Eating better throughout adult years improves physical fitness in old age, suggests study

October 18, 2017
People who have a healthier diet throughout their adult lives are more likely to be stronger and fitter in older age than those who don't, according to a new study led by the University of Southampton.

Global calcium consumption appears low, especially in Asia

October 18, 2017
Daily calcium intake among adults appears to vary quite widely around the world in distinct regional patterns, according to a new systematic review of research data ahead of World Osteoporosis Day on Friday, Oct. 20.

New study: Nearly half of US medical care comes from emergency rooms

October 17, 2017
Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.