Abstract:
Background:Inpatient HIV care often requires specialized laboratory testing with which practitioners may not be familiar. In addition, computerized physician order entry allows for ordering tests without understanding test indications, but it can also provide a venue for education and diagnostic stewardship. Methods:All charts of HIV-positive patients hospitalized at a tertiary care public safety net hospital in Houston, Texas, between January 1, 2014, and June 30, 2014, were reviewed for a set list of laboratory tests. Appropriateness of test ordering was assessed by 2 providers. Cost estimates for each test were obtained from Medicaid and a national nonprofit health care charge database. Results:A total of 274 HIV-positive patients were admitted 429 times in the 6-month study period. During the study period, 45% of the study laboratory tests ordered were not indicated. A total of 532 hepatitis serologies were ordered, only 52% of which were indicated. Overall, 71 serum qualitative cytomegalovirus (CMV) polymerase chain reactions (PCRs) and eight CMV quantitative PCRs were ordered, with most (85%) qualitative PCRs ordered for nonspecific signs of infection (eg, fever). Other tests ordered without clear indications included Aspergillus IgE (7), serum Epstein-Barr virus (EBV) PCR (5), parvovirus serology (7), and Toxoplasma IgM (18). Overall, the estimated laboratory cost of inappropriate testing over the study period was between $14 000 and $92 000, depending on which cost database was used. Conclusions:Many tests ordered in HIV-positive inpatients do not have indications, representing a substantial source of health care waste and cost and potentially leading to inappropriate treatment. Opportunities exist to decrease waste through education of trainees and hospitalists and through implementation of diagnostic stewardship via the electronic medical record.
journal_name
Open Forum Infect Disjournal_title
Open forum infectious diseasesauthors
Bolles K,Woc-Colburn L,Hamill RJ,Hemmige Vdoi
10.1093/ofid/ofz158subject
Has Abstractpub_date
2019-03-29 00:00:00pages
ofz158issue
6issn
2328-8957pii
ofz158journal_volume
6pub_type
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journal_title:Open forum infectious diseases
pub_type: 杂志文章
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journal_title:Open forum infectious diseases
pub_type: 杂志文章
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pub_type: 杂志文章,评审
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更新日期:2020-03-23 00:00:00
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abstract::[This corrects the article DOI: 10.1093/ofid/ofx156.][This corrects the article DOI: 10.1093/ofid/ofx156.]. ...
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pub_type: 杂志文章,已发布勘误
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pub_type: 杂志文章
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doi:10.1093/ofid/ofaa374
更新日期:2020-08-25 00:00:00
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pub_type: 杂志文章
doi:10.1093/ofid/ofz195
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