Medical Research: What are the main findings of the study?
Dr. Trost: In our study, we reported the use of 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.
- 1) Provided information and education to physicians about proven testing guidelines and
- 2) 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, our intervention led to an estimated $1.25 million reduction in laboratory charges.
Medical Research: Were any of the findings unexpected?
Dr. Trost: No, based on a small sample of our pre-intervention utilization pattern, we estimated that there was a significant amount of “overuse” of this testing and that reducing the “overuse” would lead to a significant reduction in laboratory charges.
Medical Research: What should clinicians and patients take away from your report?
Dr. Trost: We believe that clinicians should consider eliminating the use of CK-MB if troponin is available at their institutions, because CK-MB adds no incremental value over troponin in the evaluation and diagnosis of patients with chest pain. CK-MB is an example of a low-value (and some would argue, zero-value) test for patients.
We would also add that clinicians need to consider appropriate use of serial troponin values – typically, it only takes 2 or 3 values at most to make or exclude a diagnosis of acute coronary syndrome.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Trost: Future research could center on applying our intervention – provider education and EMR changes – to the appropriate ordering practice of other tests that are deemed to have little or no value in clinical practice.
Reducing Excess Cardiac Biomarker Testing at an Academic Medical Center
Marc R. Larochelle MD,Amy M. Knight MD,Hardin Pantle MD, Stefan Riedel MD, PhD, Jeffrey C. Trost MD
Journal of General Internal Medicine June 2014