worked on analysis part, list from Dr.Lorenz and edits |
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Worked on procedures and powerplans! |
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Worked more on methods - procedures part.; almost finished background edits. Lot of lit review on selection of tests for aim 1
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Made edits to Background. Worked on study designs for all aims.
Study Design
Aim 1:
A retrospective cohort design was used to assess the epidemiology of lab test overutilization. We used administrative/financial data for inpatient, outpatient and ED to identify baseline laboratory utilization. High volume tests were selected based on the number of tests ordered and cost. Appropriate testing intervals were defined using prior literature and local clinical expert opinion. We identified early repeat test as the tests repeated within abbreviated testing interval defined in this study. The inclusion criterion for this study was one or more of the selected high volume tests ordered electronically atleast twice during outpatient, inpatient or ER visit at UAB during the study period for patients 19 years or older.
Aim 2:
We designed a qualitative study to assess provider attitudes regarding factors associated with overutilization of laboratory tests (i.e., panel based ordering), evaluate test ordering behavior in different clinical settings (clinics, hospital, etc.), and cost awareness). We conducted one on one in depth interviews/focus groups with the providers from different clinical care settings at UAB. Emails were sent to all providers to participate in IDI/focus group. A combination of close and open ended questions was used to capture provider perspectives on laboratory test overutilization. The interviews were audio recorded and later transcribed to generate themes.
Aim3:
A retrospective study with pre and post design method was used to assess impact of utilization of panel based ordering via “power plans” before and after EMR transitions implemented at the UAB for quality control. Power plans which were part of EMR transition were selected. Data was collected in 2 phases – 6 months pre-EMR transition phase and 6 months post-EMR transition phase. A difference in the proportions of early tests ordered 6 months prior and 6 months after EMR transitions will be estimated.
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