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Effectiveness of an electronic alert on inappropriate NT-proBNP short-term repeat testing
Session:
Posters (Sessão 1 - Écran 7) - Saúde Digital e Economia da Saúde
Speaker:
Inês Miranda
Congress:
CPC 2023
Topic:
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme:
34. Public Health and Health Economics
Subtheme:
34.3 Health Economics
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Inês Pereira De Miranda; Inês Fialho; João Bicho Augusto; João Nabais; Teresa Sardinha; Daniella Azevedo; Miguel Santos
Abstract
<p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">NT-proBNP is an expensive laboratory marker used as a diagnosis and prognosis biomarker in heart failure (HF). In patients with acute decompensated HF (ADHF), it can be useful at admission and at discharge, but repeated measurement over a short period of time is potentially inappropriate and associated with unnecessary costs. The aims of this study were to determine the effectiveness of an electronic alert on reducing the prevalence of inappropriate use of NT-proBNP and estimate the potential cost savings.</span></span></p> <p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">An electronic alert was implemented on 25<sup>th</sup> Nov 2022, prompting doctors to type a clinical justification for ordering NT-proBNP whenever a result was available in the previous 5 days. The alert can easily be dismissed by typing a single character. The percentage of potentially inappropriate testing (repeat in <u><</u>5 days) was determined after the implementation (intervention period, from 25<sup>th</sup> Nov-15<sup>th</sup> Dec 2022) and compared to 2 control periods: 1<sup>st </sup>Oct-24<sup>th</sup> Nov 2022 (control period A) and 25<sup>th </sup>Nov-15<sup>th </sup>Dec 2021 (control period B). A €29.60 cost per test was used. Chi-square was used for statistical analysis.</span></span></p> <p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The total number (n) of NT-proBNP orders and the percentage (%) of repeat testing in <u><</u>5 days was: during the intervention period n=1,022 and 20%; during the control period A n=2,543 and 22%; during the control period B n=840 and 20%. The percentage of potential inappropriate testing was not significantly different when comparing the intervention period to the control period A (p=0.74) and control period B (p=0.48). The total number of NT-proBNP tests per year is around 11,000. A strategy that would reduce potential 20% inappropriate tests would save €65.120 per year.</span></span></p> <p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions: </span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Around 20% of NT-proBNP tests are ordered within 5 days or less of a previous test. An electronic alert prompting doctors to type a clinical justification for the NT-proBNP whenever a result was available in the previous 5 days is not effective. An effective intervention to reduce inappropriate testing could save over €65.000 year in a moderate dimension hospital. More effective strategies are necessary. </span></span></p>
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