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Longitudinal trends in laboratory test utilization at a large tertiary care university hospital in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry. (Biokemisk struktur och funktion)
2011 (English)In: Uppsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 116, no 1, 34-38 p.Article in journal (Refereed) Published
Abstract [en]

Background. The aim of the study was to describe and evaluate longitudinal trends in laboratory test utilization over a 7-year period from 2002 to 2008. Method. Retrospective study using test request data from the Clinical Chemistry and Pharmacology Laboratory at Akademiska Sjukhuset, a large tertiary care university hospital in Sweden. Changes in test utilization, charges, and expenditures during the study period were used as main outcome measures. Results. Laboratory test utilization increased by over 70%, with a mean annual increase of 9.3% during the study period. After adjustment for inflation, the laboratory expenditures increased by 20.2% during the study period but represented only approximately 2.0% of the hospital's total expenditure in 2008. The test menu comprised 663 tests in 2008, an increase by 146% from 2002. The mean inflation-adjusted unit price charged per test increased from €34.9 to €37.5 during the study period. The top 10, 20, and 30 tests accounted for, on average, 46.9%, 66.9%, and 75.5% of the total test volume during the study period, and 47.8%, 66.4%, and 75.7% of the total test volume in 2008. In 2008, 10 analyses, i.e. 1.5% of the number of tests on the menu, accounted for almost half the number of generated test results. Conclusions. The total number of generated test results increased by over 70% in less than a decade. Even so, the laboratory's share of the hospital's total expenditure remained low and virtually unchanged. A very small number of tests accounted for a disproportionately large share of the total number of generated test results.

 

Place, publisher, year, edition, pages
2011. Vol. 116, no 1, 34-38 p.
Keyword [en]
clinical laboratory techniques, clinical chemistry, economics of laboratory operation, health care costs, laboratory management, test utilization, trends
National Category
Other Clinical Medicine
Research subject
Biomedical Laboratory Science
Identifiers
URN: urn:nbn:se:uu:diva-120553DOI: 10.3109/03009734.2010.528071ISI: 000287312100005PubMedID: 21067458OAI: oai:DiVA.org:uu-120553DiVA: diva2:303559
Available from: 2010-03-12 Created: 2010-03-12 Last updated: 2011-03-07Bibliographically approved
In thesis
1. The Use of Laboratory Analyses in Sweden: Quality and Cost-Effectiveness in Test Utilization
Open this publication in new window or tab >>The Use of Laboratory Analyses in Sweden: Quality and Cost-Effectiveness in Test Utilization
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization.

Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings.

It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians.

Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease.

Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values.

In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 538
Keyword
continuing medical education, cost control, cost savings, physician practice patterns, diagnostic tests, clinical chemistry, primary health care, health care costs, laboratory management, test utilization, trends, cost-effectiveness, inflammatory bowel disease, irritable bowel syndrome, calprotectin, cost avoidance
National Category
Other Clinical Medicine
Research subject
Biomedical Laboratory Science
Identifiers
urn:nbn:se:uu:diva-120554 (URN)978-91-554-7751-6 (ISBN)
Public defence
2010-05-07, Enghoffsalen, Ing 50, bv, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-14 Created: 2010-03-12 Last updated: 2010-04-16

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