Utilization Management Program Research Articles

Real-world evidence of a successful biosimilar adoption program.

Biosimilars have introduced new opportunities to reduce the disproportionately high US healthcare spending on biologic medications. This article describes strategic utilization management program initiatives designed to promote biosimilar utilization, reduce biologic drug costsand increase sustainability in a USnonprofit health system. Key components of these biosimilar utilization management program initiatives included expedited procedures to evaluate and establish the formulary status of biosimilars, enhanced contracting negotiations, specially designed electronic medical record tools to guide physician prescribing, payer coverage analysis, evaluations of biologic-utilization trendsand financial performance analysis. Within 2years (2019-2020), this program has resulted in savings of USD$26.9million for Providence St Joseph Health and biosimilar adoption rates that greatly exceed the USnational average.

Current state of laboratory test utilization practices in the clinical laboratory

Appropriate laboratory test utilization is of growing interest in the face of rising healthcare costs and documented evidence of over- and under-utilization. Building from published literature, laboratory organizations have recently published guidelines for establishing laboratory utilization management programs. However, systematic reviews and meta-analyses have consistently struggled to define rigorous evidence-based best practice recommendations due to the paucity of published data or the heterogeneity of available data. We sought to gain information about utilization practices and programs currently in use and which factors contribute to their success by distributing a survey among laboratory professionals. The survey received seventy-four eligible respondents. We observed a wide range in the duration of laboratory utilization programs and the number of stewardship initiatives. In addition, there was great variety in the utilization practices used and the tests or processes targeted by programs. There was similarity in how initiatives are evaluated and who is involved with utilization programs. Finally, respondents often credited a multidisciplinary committee, support from leadership, and strong IT support/data access as important factors for their program's perceived success. Many of these factors agree with previously published literature.

Developing a multidisciplinary HCV direct-acting antivirals utilization management and assessment program

BackgroundThe introduction of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infections has revolutionized outcomes for patients with HCV. Cost-effective use of these antivirals in addition to ensuring patient adherence is of paramount importance. ObjectivesThe goal of this article is to describe the processes by which a tertiary care, multisite institution managed the complexities involved in administering DAA treatment and managing the increased cost of therapy. Specifically, the objectives of this article are to describe the development of a multidisciplinary HCV management program and the role of pharmacists in this program, including formulary management strategies and monitoring of DAAs use in our institution, development of guidelines, electronic prescribing protocols and order sets, and specific outcomes based on a concurrent medication use evaluation. Practice descriptionKing Faisal Specialist Hospital and Research Centre is a tertiary care referral hospital. As a tertiary referral hospital, it offers primary and highly specialized inpatient and outpatient medical care. The process of selecting and developing institutional HCV management program is described. Practice innovationThis article provides key details regarding how a multidisciplinary HCV program using DAAs can be implemented successfully at a tertiary care facility. Key facets of our innovation include establishing formulary guidelines, setting up eligibility criteria for patients, and establishing an HCV taskforce and multidisciplinary HCV program clinic. EvaluationMedication use evaluations were regularly conducted to monitor sustained virologic response rates, adherence to guidelines, adverse reactions, and drug interactions. Methods: Formulary guidelines, setting up an eligibility criterion for patients, and an HCV taskforce and multidisciplinary HCV program clinic were established. ResultsThe involvement of pharmacists in a multidisciplinary HCV program in outpatient settings resulted in improved formulary decision making, reduction of costs, and improvement of adherence to institutional guidelines. Practice implicationsThe role of a pharmacist in the management of patients with HCV with DAAs is important. Pharmacists play an integral part in medication management and overall reduction in health care expenditure. Many disease management programs can be complemented with pharmacists to improve patient care and reduce cost. ConclusionHCV treatment is challenging, and a multidisciplinary approach to treat HCV is critical. It is a rapidly evolving field; therefore, it requires dynamic formulary management and collaborative practice approaches to monitor pharmacotherapy carefully and efficiently. Clinical pharmacists play a pivotal role within the multidisciplinary team by providing support to both patients and health care providers with regard to the treatment of HCV.

The Joint Utilization Management Program—Implementation of a Bundle Payment Model and Comparison Between Year 1 and 2 Results

BackgroundHealth care spending is projected to increase throughout the next decade alongside the number of total joint arthroplasties (TJAs) performed. Such growth places significant financial burden on the economic system. To address these concerns, Bundled Payments for Care Improvement (BPCI) is becoming a favorable reimbursement model. The aim of this study is to present the outcomes with BPCI model focused on the post–acute care (PAC) phase and compare the outcomes between years 1 and 2 of implementation. MethodsThe Joint Utilization Management Program (JUMP) was implemented in January 2014. Inclusion criteria were Medicare patients undergoing primary unilateral in-patient TJA procedures, outpatient procedures that resulted in an in-hospital admission, and trauma episodes that required TJA. Scorecards monitoring surgeons' performance and tracking length of stay (LOS) in the PAC setting were established. The data generated from these scorecards guided percentage sum-allocation from the total gain-shared sum among the participating providers. ResultsA total of 683 JUMP patients were assessed over two years. PAC utilization decreased between 2014 and 2015. The average LOS was longer in year 1 than year 2 (4.50 vs 3.19 days). In-patient rehabilitation (IPR) decreased from 6.45% to 3.22%, with a decrease in IPR average LOS of 1.47 days. The rate of 30-day readmission was lower for JUMP patients in 2015 than 2014 (8.77% vs 10.56%), with day of readmission being earlier (11.91 days vs 13.71 days) in 2014. ConclusionUnder the BPCI program, our experience with the JUMP model demonstrates higher efficiency of care in the PAC setting through reduced LOS, IPR admission rates, and 30-day readmission rate.

Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users.

The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse. To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations). The CSUM program identified patients who received ≥10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis. After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits. The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular. Funding for this study was provided by Anthem, which had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Ma, Barron, DeVries, and Agiro are employees of HealthCore, a wholly owned subsidiary of Anthem. Horn is an employee of Anthem.

AMCP Partnership Forum: Managing Total Cost of Care Through Medical and Pharmacy Data Integration.

Value-driven health care models that aim to improve patient outcomes while managing total costs of care require better access to integrated health care data. Health care organizations that integrate data from multiple platforms (e.g., pharmacy, medical, electronic medical records, and lab data) can better streamline and guide effective, efficient, and coordinated utilization and care management programs. To address strategies for integrating health care data, the Academy of Managed Care Pharmacy convened a forum in Baltimore, MD, on September 25-26, 2018. The goal of the forum was to develop a roadmap for managed care entities interested in (a) managing medications across the spectrum of health care-regardless of whether the medications are covered by a medical or pharmacy benefit; (b) driving performance improvements in clinical quality with integrated datasets; (c) streamlining care transitions and case management; and (d) facilitating the development of datasets formatted for use in value-based care contracts. Forum deliberations highlighted the need for data integration in value-based health care systems, explored making data actionable through rapid and predictive analytics of integrated datasets, identified the challenges of doing so, and developed a practical roadmap for managing the total cost of care through data integration. Health care leaders representing health plans, integrated delivery systems, pharmacy benefit managers, employers, the federal government, technology companies, data integrators, standards development leaders, and biopharmaceutical companies participated in the forum, which was supported in collaboration with Abbvie, Alkermes, Amgen, Bayer, Boehringer Ingelheim, Genentech, Merck, National Pharmaceutical Council, PhRMA, Takeda, and Xcenda. These proceedings represent common themes and comments from individual participants; they are not necessarily endorsed by all attendees, nor should they be construed as reflecting group consensus. DISCLOSURES: The AMCP Partnership Forum and the development of this proceedings document were supported by Abbvie, Alkermes, Amgen, Bayer, Boehringer Ingelheim, Genentech, Merck, National Pharmaceutical Council, PhRMA, Takeda, and Xcenda.

Creation and Use of an Electronic Health Record Reporting Database to Improve a Laboratory Test Utilization Program.

Laboratory-based utilization management programs typically rely primarily on data derived from the laboratory information system to analyze testing volumes for trends and utilization concerns. We wished to examine the ability of an electronic health record (EHR) laboratory orders database to improve a laboratory utilization program. We obtained a daily file from our EHR containing data related to laboratory test ordering. We then used an automated process to import this file into a database to facilitate self-service queries and analysis. The EHR laboratory orders database has proven to be an important addition to our utilization management program. We provide three representative examples of how the EHR laboratory orders database has been used to address common utilization issues. We demonstrate that analysis of EHR laboratory orders data has been able to provide unique insights that cannot be obtained by review of laboratory information system data alone. Further, we provide recommendations on key EHR data fields of importance to laboratory utilization efforts. We demonstrate that an EHR laboratory orders database may be a useful tool in the monitoring and optimization of laboratory testing. We recommend that health care systems develop and maintain a database of EHR laboratory orders data and integrate this data with their laboratory utilization programs.

59 Impact of a Laboratory-Based Utilization Management Program on Hereditary Hemochromatosis HFE Gene Testing

59 Impact of a Laboratory-Based Utilization Management Program on Hereditary Hemochromatosis HFE Gene Testing

The impact of a health plan utilization management program on sedative hypnotic related hospital admissions in the elderly

The impact of a health plan utilization management program on sedative hypnotic related hospital admissions in the elderly

Utilization Management of High-Cost Imaging in an Outpatient Setting in a Large Stable Patient and Provider Cohort over 7 Years.

Purpose To quantify the effect of a comprehensive, long-term, provider-led utilization management (UM) program on high-cost imaging (computed tomography, magnetic resonance imaging, nuclear imaging, and positron emission tomography) performed on an outpatient basis. Materials and Methods This retrospective, 7-year cohort study included all patients regularly seen by primary care physicians (PCPs) at an urban academic medical center. The main outcome was the number of outpatient high-cost imaging examinations per patient per year ordered by the patient's PCP or by any specialist. The authors determined the probability of a patient undergoing any high-cost imaging procedure during a study year and the number of examinations per patient per year (intensity) in patients who underwent high-cost imaging. Risk-adjusted hierarchical models were used to directly quantify the physician component of variation in probability and intensity of high-cost imaging use, and clinicians were provided with regular comparative feedback on the basis of the results. Observed trends in high-cost imaging use and provider variation were compared with the same measures for outpatient laboratory studies because laboratory use was not subject to UM during this period. Finally, per-member per-year high-cost imaging use data were compared with statewide high-cost imaging use data from a major private payer on the basis of the same claim set. Results The patient cohort steadily increased in size from 88 959 in 2007 to 109 823 in 2013. Overall high-cost imaging utilization went from 0.43 examinations per year in 2007 to 0.34 examinations per year in 2013, a decrease of 21.33% (P < .0001). At the same time, similarly adjusted routine laboratory study utilization decreased by less than half that rate (9.4%, P < .0001). On the basis of unadjusted data, outpatient high-cost imaging utilization in this cohort decreased 28%, compared with a 20% decrease in statewide utilization (P = .0023). Conclusion Analysis of high-cost imaging utilization in a stable cohort of patients cared for by PCPs during a 7-year period showed that comprehensive UM can produce a significant and sustained reduction in risk-adjusted per-patient year outpatient high-cost imaging volume. © RSNA, 2017.

The value of open access and a patient centric approach to oral oncolytic utilization in the treatment of Chronic Myelogenous Leukemia: A U.S. perspective

ABSTRACTIntroduction: Since the introduction of tyrosine kinase inhibitors (TKIs), the treatment of patients with chronic myelogenous leukemia (CML) has resulted in significant improvement in patient survival but at a higher pharmaceutical cost to payers. The recent introduction of generic imatinib presents an opportunity to lower pharmacy costs within a population that is growing due to improved survival. Recent literature has focused on the likely benefits to payers of step therapy through generic imatinib.Areas covered: This review provides a perspective that is broader than the evaluation of financial savings or narrowly defined health economic metrics by incorporating factors such as CML patient heterogeneity, including varying levels of disease progression risk, comorbidities and genetic mutation status, differences in TKI product profiles, clinical guideline recommendations, and the importance of individualized patient care. A focused literature review evaluating the real-world impact of utilization management programs is presented.Expert commentary: The findings indicate that payers can achieve substantial savings without the need to implement utilization management policies. Compromises in the ability to provide individualized patient care and unwanted economic consequences resulting from increased costs of disease progression, adverse events, and lack of response to treatment due to utilization management are summarized.

Promoting appropriate genetic testing: the impact of a combined test review and consultative service

Genetic test misorders can adversely affect patient care. However, little is known about the types of misorders and the overall impact of a utilization management (UM) program on curbing misorders. This study aimed to identify different types of misorders and analyze the impact of a combined test review and consultative service on reducing misorders over time. Selected genetic tests were systematically reviewed between January and December 2015 at Stanford Health Care. Misorders were categorized into five types: clerical errors, redundant testing, better alternatives, controversial, and uncategorized. Moreover, consultations were offered to help clinicians with test selection. Of the 629 molecular test orders reviewed, 13% were classified as misorders, and 7% were modified or canceled. Controversial misorders constitute the most common type (42%); however, unlike the other misorder types, they were negligibly affected by test review. Simultaneously, 71 consults were received. With the introduction of the UM program, genetic test misorders went from 22% at baseline to 3% at the end of the year. Our results show that the combined approach of test review and consultative service effectively reduced misorders over time and suggest that a UM program focused on eliminating misorders can positively influence health-care providers' behaviors.Genet Med advance online publication 26 January 2017.

Preventing Genetic Testing Order Errors With a Laboratory Utilization Management Program.

To characterize error rates for genetic test orders between medical specialties and in different settings by examining detailed order information. We performed a retrospective analysis of a detailed utilization management case database, comprising 2.5 years of data and almost 1,400 genetic test orders. After review by multiple reviewers, we categorized order modifications and cancellations, quantified rates of positive results and order errors, and compared genetics with nongenetics providers and inpatient with outpatient orders. High cost or problems with preauthorization were the most common reasons for modification and cancellation, respectively. The cancellation rate for nongenetics providers was three times the rate for geneticists, but abnormal result rates were similar between the two groups. The approval rate for inpatient orders was not significantly lower than outpatient orders, and abnormal result rates were similar for these two groups as well. Order error rates were approximately 8% among tests recommended by genetics providers in the inpatient setting, and tests ordered or recommended by nongeneticists had error rates near 5% in both inpatient and outpatient settings. Clinicians without specialty training in genetics make genetic test order errors at a significantly higher rate than geneticists. A laboratory utilization management program prevents these order errors from becoming diagnostic errors and reaching the patient.

Impact of a Collaborative Radiology Utilization Management Program: Does the Specialty of the Referring Provider Matter?

The purpose of this study was to evaluate the impact of a collaborative radiology utilization management program on the disposition of cases according to provider specialty. A utilization management program directed by a radiology benefit management company provided peer-to-peer decision support for providers ordering advanced outpatient imaging studies. After a radiologist reviewed the cases, based upon provider specialty, the rates of the following dispositions were analyzed: study approved by consensus, study changed by consensus, study not performed by consensus, study approved (no consensus), and study administratively not performed (no callback). Aggregated rates of study changed or not performed by consensus (withdrawals) were used to assess the effect of provider-radiologist collaboration. The rate of no callback was used to assess sentinel effect. The combined rate of withdrawals and no callback represented the overall impact of radiologist participation. The project period was 5 years. A total of 168,915 studies were reviewed: 58.6% were approved, 6.8% were changed, and 13.5% were withdrawn by consensus; 6.0% were approved without consensus; 15.2% were withdrawn because of no callback; 35.5% initially ordered were not performed at the time they were ordered. Family practice (25.3%) and internal medicine (23.8%) had the highest aggregated rates of study changed or withdrawn by consensus. Thoracic surgery (13.3%), neurosurgery (11.2%), and orthopedic surgery (9.3%) had the lowest rates. Internal medicine (18.0%), neurology (17.7%), and family practice (17.4%) had the highest rates of study withdrawn owing to no callback. Pediatrics (7.1%) and ophthalmology (7.3%) had the lowest rates. The overall impact was greatest for family practice (42.7%), internal medicine (41.8%), and neurology (33.4%) and least for orthopedic surgery (22.8%) and neurosurgery (24.0%). Radiologist participation had substantial impact regardless of provider specialty. The impact was greatest on primary care providers who are heavier users of radiology.

Moriates C, Arora V, Shah N, eds. Understanding Value-Based Healthcare .

C Moriates, V Arora, N Shah, eds. Understanding Value-Based Healthcare . New York, NY: McGraw-Hill Education, 2015, 416 pp, $49.50. The health care system is under increasing pressure to provide value. Although quality is the most important part of this equation, greater attention is being placed on the cost component of the equation. Within pathology, most hospitals have begun utilization management programs that are designed to reduce waste and increase value. Pathologists and laboratorians, however, need to become more knowledgeable and proactive to help the health care system provide greater value in health care. Understanding Value-Based Healthcare was written for physicians and other health care providers. It is not about high-level policy or economics. Rather, it is about actions that those on the front lines of health care can take to improve value. Although the book is written for a wide audience, it covers many topics that are relevant to pathologists. The book contains 16 chapters that are divided into three sections. The first section, “Introduction to Value in Healthcare,” has six chapters that provide background material. The first chapter describes how health care has become increasingly complex, inefficient, and expensive. As a result, approximately one-third of health care dollars are wasted. Compared with other countries, the US system fails to deliver value. This chapter is …

A New Management Healthcare Systems to Efficiently Reduce Healthcare Costs: Clinical Pharmaceutical Care, Medical Laboratory Imaging, Nuclear Medicine: A Synergy Instruments

ASHP Guidelines: Clinical pharmacy service, in which pharmacist provide direct patient care are important foundation for successful medication utilization management program focused on managing drug cost. The purpose of this work is to analyze the advantages played by ward clinical pharmacists as stabile members of medical equips with physicians, other healthcare professionals and nurse. Using the data obtained by diagnostic activity (medicine laboratory and imaging) to choose and monitor the therapy clinical pharmacist can reduce therapy costs in the same time improve patients clinical outcomes, and increase of patients quality of life and safety. The application of management and ICT principle can give significant reducing in healthcare process.

Management Instrument in Pharmaceutical Care and Clinical Pharmacy

In actual scenario of international economic cycle, rational use of drugs and medical devices has become a real priority in order to correctly use the limited economic resources available today. Healthcare government and public or private institutions, insurance company and other subject are involved in high costs management much more than past (in example cost for drugs, medical devices and, new diagnostic procedure). Healthcare managers ask the clinical pharmacist professionals to rationalize costs involved in new innovative therapy, due to medical therapy errors and also in order to have efficient logistic systems (hospital pharmacy). For this reason Clinical pharmacist every day work in healthcare setting are strongly applied to monitor high costs related to diagnostics procedures and drug therapies. But Clinical pharmacists professional need to have management instruments to be added to their classic university core curriculum (Knowledge and practice applications). A rational use of clinical pharmacist’s human resource is a golden endpoint in every setting with the change from logistic to more clinical function (clinical pharmaceutical care new healthcare discipline. According to ASHP Guidelines report: “clinical pharmacy service, in which pharmacist provide direct patient care are important foundation for successful medication utilization management program focused on managing drug cost” in this article we analyze biomedical literature involved giving some elements for improving management skills to be active part of medical team in management and monitoring costs. (Clinical pharmacist help physicians in this kind of work) clinical pharmacy competence added to management instruments can be considered the right keyword and a synergy.

Abstract 262: A Comparative Study of the Efficiency of Non-Invasive Imaging Modalities in the Evaluation of Outpatient Chest Pain and the Sequential Relationship between Coronary Imaging Modalities Leading to Percutaneous Coronary Interventions at the Patient Level

Background: As catheterizations can lead to complications, assessing chest pain patients for coronary artery disease with non-invasive methods has the potential to improve the quality of care. However, there is limited evidence comparing subsequent procedures following initial assessments. To investigate the role of coronary computed tomographic angiography (CCTA) as an initial assessment, this study had two aims: 1) quantify catheterizations following initial non-invasive workups, and 2) evaluate the rate of stent placement following either initial CCTA assessment or catheterization without CCTA. Methods: This was a retrospective analysis using administrative claims data from a large, national health insurer with a cardiac utilization management program. To assess the first aim, patients diagnosed with chest pain who received one of the following initial assessments in 2010 were selected: stress echocardiogram (STE), cardiac nuclear scan (CNUC), or CCTA. Continuous enrollment for 24 months after the initial assessment and no prior chest pain diagnosis or related-procedure in the year prior to the index procedure was required. The number of patients receiving 1, 2, and 3 procedures, as well as the proportion of patients with a catheterization following their initial assessment was reported. To assess the second aim, patients who had either an initial CCTA or a catheterization with no CCTA during 2011-2012 were selected. Patients receiving a stent prior to the CCTA or catheterization were excluded. The rate of stent placement in the 30 days after the initial CCTA assessment or the catheterization was compared for each group using a two-tailed t-test. Results: CNUC was the most common initial procedure. Among the initial assessments, 50.4% of Medicare patients with CNUC had a catheterization, compared to 26.8% with CCTA and 21.6% with STE. Most of the Medicare patients had 1 procedure; 36.1% had 2 or more procedures and 12.0% had 3 procedures. The evaluation of stent placement found that stents were more common in the group that had a catheterization but no CCTA (22.2%) compared to the group that had an initial CCTA assessment (7.4%), p&lt;0.001. Among those with an initial CCTA, 30.2% had a catheterization and 24.6% of those went on to have a stent. The difference in the rate of transition from catheterization to stent in the two populations was not statistically significant, p=0.37. Conclusions: These results suggest that CCTA or STE as an initial, non-invasive cardiac procedure may reduce cardiac catheterization, thereby reducing radiation exposure and risk of complications from invasive tests. The rate of stent placement was lower among those who had an initial CCTA assessment, compared to when catheterization was used alone. CCTA’s role can be clarified through prospective, randomized studies.

A bayesian approach to laboratory utilization management

Background: Laboratory utilization management describes a process designed to increase healthcare value by altering requests for laboratory services. A typical approach to monitor and prioritize interventions involves audits of laboratory orders against specific criteria, defined as rule-based laboratory utilization management. This approach has inherent limitations. First, rules are inflexible. They adapt poorly to the ambiguity of medical decision-making. Second, rules judge the context of a decision instead of the patient outcome allowing an order to simultaneously save a life and break a rule. Third, rules can threaten physician autonomy when used in a performance evaluation. Methods: We developed an alternative to rule-based laboratory utilization. The core idea comes from a formula used in epidemiology to estimate disease prevalence. The equation relates four terms: the prevalence of disease, the proportion of positive tests, test sensitivity and test specificity. When applied to a laboratory utilization audit, the formula estimates the prevalence of disease (pretest probability [PTP]) in the patients tested. The comparison of PTPs among different providers, provider groups, or patient cohorts produces an objective evaluation of laboratory requests. We demonstrate the model in a review of tests for enterovirus (EV) meningitis. Results: The model identified subpopulations within the cohort with a low prevalence of disease. These low prevalence groups shared demographic and seasonal factors known to protect against EV meningitis. This suggests too many orders occurred from patients at low risk for EV. Conclusion: We introduce a new method for laboratory utilization management programs to audit laboratory services.

Impact of a Utilization Management Program on Reducing Unnecessary Test Orders for 1,25-Dihydroxyvitamin D

Impact of a Utilization Management Program on Reducing Unnecessary Test Orders for 1,25-Dihydroxyvitamin D