Utilization management gets a hand | POC experiment in diabetes | Should breast cancer genetic testing be broadened?

Dear LabPulse Member,

The value imperative for clinical labs is unsurprisingly spurring research into technological tools to help ensure that the right diagnostic tests are ordered for the right patients at the right time.

In a bioinformatics study from three major academic institutions published in JAMA Network Open, researchers noted that 25% to 50% of inpatient lab testing in the U.S. is medically unnecessary, with clinical and financial consequences for the health system overall. The many reasons for failing to follow appropriate use guidelines and ordering unnecessary tests include a desire for certainty, pressure to be thorough, patient demand, and malpractice concerns. Some machine-learning models evaluated by the researchers, however, could have predicted the low utility of commonly performed tests with high accuracy, according to the retrospective study.

Underuse of testing is also a problem, though, and can result in higher rates of complications and costs for a health system. We reported on a successful effort by public health officials in Denton County, Texas, to ensure that low-income residents at risk of diabetes were getting their blood sugar tested through a point-of-care outreach program. Officials achieved a 38% overall reduction in hemoglobin A1c levels, which they believe may help dramatically lower rates of future complications, such as amputation, heart failure, and stroke.

Genetic testing in breast cancer is another area of underuse, according to some experts. Knowing the genetic profile of a tumor helps steer patients to the right treatments and can also alert family members of their own potential risk. The complexity of genetic screening criteria and barriers to its use drew attention again in a study of 100 patients with metastatic breast cancer. Researchers identified pathogenic and likely pathogenic variants they said would never have been picked up using guidelines from the National Comprehensive Cancer Network.

Meanwhile, we are looking ahead to the College of American Pathologists annual meeting, slated for September 21-25 in Orlando, FL. The meeting will feature lectures on how the specialty can take the lead on smart test ordering and how labs can adapt in the value-based healthcare environment, among other sessions. We are packing our bags and hope to meet some of you there in person.

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