(Press-News.org) An analysis of patients with coronary heart disease (CHD) who attained low-density lipoprotein cholesterol (LDL-C) goals with no treatment intensification suggests that about one-third of them underwent repeat testing, according to a report published by JAMA Internal Medicine, a JAMA Network publication.
The authors note in the study background that the frequency and correlates of repeat lipid testing in patients with CHD who have already achieved Adult Treatment Panel III guideline-recommended LDL-C treatment targets and received no treatment intensification are unknown. The guideline-recommended LDL-C target is less than 100 mg/dL.
"In these patients, repeat lipid testing may represent health resource overuse and possibly waste of health care resources," according to the study.
Salim S. Virani, M.D., Ph.D., of the Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, Houston, Texas, and colleagues analyzed a total of 35,191 patients with CHD in a VA network of seven medical centers. Of 27,947 patients with LDL-C levels less than 100 mg/dL, 9,200 (32.9 percent) had additional lipid tests without treatment intensification during the following 11 months, the study results indicate.
According to the authors, "Collectively, these 9,200 patients with CHD had a total of 12,686 additional lipid panels performed. With a mean lipid panel cost of $16.08...this is equivalent to $203,990 in annual costs for one VA network and does not take into account the cost of the patient's time to undergo lipid testing and the cost of the provider's time to manage these results and notify the patient."
"Our results highlight areas to target for future quality improvement initiatives aimed at reducing redundant lipid testing in patients with CHD," the study concludes.
###
(JAMA Intern Med. Published online July 1, 2013. doi:10.1001/jamainternmed.2013.8198. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Authors made conflict of interest and funding disclosures. This work was also supported by a Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence grant and by a Veterans Affairs contract. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Physician Performance Measurement
In a related commentary, Joseph P. Drozda, Jr., M.D., Center for Innovative Care, Chesterfield, Mo., writes: "The investigators conclude that this represents redundant testing and is a target for quality improvement efforts and believe this would be even more important if the forthcoming Adult Treatment Panel IV guidelines call for a medication dose-based approach to lipid management as opposed to the current treat-to-target approach."
"This well-conceived study on a large clinical database, which has the advantage of containing pharmacy data for use in tracking medication adherence, delivers an important message regarding a type of waste that is likely widespread in health care and that goes under the radar because it involves a low-cost test," Drozda continues.
"However, it is precisely these low-cost, high-volume tests and procedures that need to be addressed if significant savings from reduction of waste are to be realized," Drozda concludes.
(JAMA Intern Med. Published online July 1, 2013. doi:10.1001/jamainternmed.2013.6808. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Study suggests quality initiatives needed to reduce repeat lipid testing
2013-07-02
ELSE PRESS RELEASES FROM THIS DATE:
The effect on work loss of different treatments for rheumatoid arthritis
2013-07-02
Treatment with a biological agent was not superior to conventional treatment in terms of the effect on work loss over 21 months in patients with early rheumatoid arthritis (RA) who responded insufficiently to methotrexate, according to a report published by JAMA Internal Medicine, a JAMA Network publication.
The introduction of biological tumor necrosis factor inhibitors has improved the treatment of RA but at a substantial cost, according to the study background.
From a randomized clinical trial, Jonas K. Eriksson, M.Sc., of the Karolinska Institutet, Sweden, and colleagues ...
Exercise-induced improvements in glycemic control and type 2 diabetes
2013-07-02
Exercise-induced improvements in glycemic control are dependent on the pre-training glycemic level, and although moderate-intensity aerobic exercise can improve glycemic control, individuals with ambient hyperglycemia (high blood glucose) are more likely to be nonresponders, according to a research letter by Thomas P. J. Solomon, Ph.D. of the Centre of Inflammation and Metabolism, Copenhagen, Denmark, and colleagues.
A total of 105 older (average age 61 years), overweight or obese individuals with impaired glucose tolerance or type 2 diabetes mellitus (T2DM) participated ...
Vital sign collection based on patient risk for clinical deterioration
2013-07-02
Nighttime frequency of vital signs monitoring for low-risk medical inpatients might be reduced, according to a research letter by Jordan C. Yoder, B.A. and colleagues at the University of Chicago.
Overnight vital signs are collected frequently among hospitalized patients regardless of their risk of clinical deterioration and these vital checks may have negative effects on low-risk patients such as patient distress and sleep deprivation, according to the study.
In total, 54,096 patients were included in the study, accounting for 182,828 patient-days and 1,699 adverse ...
Early childhood respiratory infections may be potential risk factor for type 1 diabetes mellitus
2013-07-02
Respiratory infections in early childhood may be a potential risk factor for developing type 1 diabetes mellitus (T1D), according to a study published by JAMA Pediatrics, a JAMA Network publication.
The incidence of T1D is increasing worldwide, although its etiology is not well understood. Infections have been discussed as an important environmental determinant, according to the study background.
Andreas Beyerlein, Ph.D., from the Institute of Diabetes Research, Munich, Germany, and colleagues sought to determine whether early, short-term or cumulative exposures to ...
New generation electronic games boosts kids' physical activity at home
2013-07-02
Most electronic games are no better than watching TV in terms of the body movement and energy expenditure involved, say the authors. Kids in developed countries spend an estimated 38 to 90 minutes a day playing these games.
But what has not been clear is whether the newer generation "active" games, such as Sony PlayStation EyeToy and Move, dance mats, and Microsoft Xbox Kinect, are any better.
The Australian researchers compared the impact of removing traditional electronic games, involving a game pad, from the home or replacing them with more active newer generation ...
1 in 5 UK NHS staff report bullying by colleagues
2013-07-02
One in five UK NHS staff report bullying by colleagues, with almost half saying they have witnessed bullying, in the past six months, indicates research published in the online journal BMJ Open.
Managers are the most common source of bullying, with workload pressures and organisational culture contributory factors, the study reveals.
The findings are based on the responses of almost 3000 NHS staff (46% response rate) to a validated questionnaire (NAQ-R), designed to tease out exposure to negative and bullying behaviours. The 12 item General Health Questionnaire (GHQ-12) ...
Long term night shifts linked to doubling of breast cancer risk
2013-07-02
Shift work has been suggested as a risk factor for breast cancer, but there has been some doubt about the strength of the findings, largely because of issues around the assessment of exposure and the failure to capture the diversity of shift work patterns. Several previous studies have also been confined to nurses rather than the general population.
In this study, the researchers assessed whether night shifts were linked to an increased risk of breast cancer among 1134 women with breast cancer and 1179 women without the disease, but of the same age, in Vancouver, British ...
Supersense: It's a snap for crocs
2013-07-02
Previously misunderstood multi-sensory organs in the skin of crocodylians are sensitive to touch, heat, cold, and the chemicals in their environment, finds research in BioMed Central's open access journal EvoDevo. These sensors have no equivalent in any other vertebrate.
Crocodylians, the group that includes crocodiles, gharials, alligators and caimans, have particularly tough epidermal scales consisting of keratin and bony plates for added protection. On the head, these scales are unusual because they result from cracking of the hardened skin, rather than their shape ...
Treating TB: What needs to be done to improve treatment rates
2013-07-02
People with tuberculosis (TB) in China often delay going to see a doctor for more than two weeks, finds research in BioMed Central's open access journal BMC Medicine. Reasons for this include a poor understanding of TB, increasing costs of treatment not covered by health insurance, and using traditional approaches first. Even after going to a clinic there were still delays in treatment, especially in rural areas, due to a lack of qualified medical staff.
Worldwide TB remains a leading cause of death, and China has the second largest TB epidemic with the most number of ...
Study examines out-of hospital stroke policy at Chicago hospitals
2013-07-02
Implementing an out-of hospital stroke policy in some Chicago hospitals was associated with significant improvements in emergency medical services use and increased intravenous tissue plasminogen activator (tPA) use at primary stroke centers, according to a study published by JAMA Neurology.
The study evaluated the relationship between a citywide policy recommending pre-hospital triage of patients with suspected stroke to transport them to the nearest primary stroke center and use of intravenous tPA use. The therapy is used to restore blood flow through blocked arteries ...