Centre for Health Systems and Safety Research

Examination of changes in pathology tests ordered by Diagnosis-Related Group (DRGs) following CPOE introduction

E Vecellio 1, A Georgiou 1, G Toouli 1, A Eigenstetter 2, L Li 1, R Wilson 2, JI Westbrook 1

1 Centre for Health Systems and Safety Research, University of New South Wales, Sydney, NSW2 South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW

Research Areas

Background

• Too many tests?

• Too few tests?

• The ‘just right’ number of tests?

Background

Overall Test Volume

Test Order Rate Per Patient Day

Background

DRG as a grouping variable

DRG

Variance

DRGOther

Length of stay

Ancillary service utilisation

Nursing hours

Kuczynski et al. (1997) Vascular surgeons' resource use at a university hospital related to diagnostic-related group and source of admission. J Vasc Surg

20-25%

Research Questions

Test Order Rate Per DRG Per Patient (Per Day)

DRG

Research Questions

Monitor test volume during the implementation of EMR

Research Questions

Compare Six Hospitals

• EMR incorporated Cerner PowerChart CPOE system. (Initially, version 2007 then, during 2011, version 2010.)

• The EMR was implemented at the six hospitals gradually between Oct 2008 and Oct 2009.

• Our dataset included two-months of data (Aug-Sep) for each of four years (2008-2011).

• 2011: EMR used for ~66% of pathology orders

Setting and Methods

Data Linkage

Image: FreeDigitalPhotos.net renjith krishnan

Data Linkage

Image: FreeDigitalPhotos.net renjith krishnan

Pathology tests: 1,256,079Inpatient admissions: 71,191

Results

2008 2009 2010 20110

5

10

15

20

25

Series1Series2Overall (Top-5 DRGs)

Mea

n N

um

ber

of

Test

s p

er I

np

atie

nt

EMR@6 HospitalsEMR@3

2008 2009 2010 201125

75

125

175

225

TracheostomyRehabilitationRespiratory Infec-tion

Results

2008 2009 2010 20110

5

10

15

20

25

HaemodialysisChest PainOverall (Top-5 DRGs)

Mea

n N

um

ber

of

Test

s p

er I

np

atie

nt

EMR@6 HospitalsEMR@3

Research Questions

Compare Four EDsDRG: Chest Pain (F74Z)

Image: FreeDigitalPhotos.net / nokhoog_buchachon

Data Linkage

Image: FreeDigitalPhotos.net renjith krishnan

Pathology tests: 6,803ED presentations: 988

DRG: Chest Pain (F74Z)Image: FreeDigitalPhotos.net / nokhoog_buchachon

ResultsM

ean

Rat

e o

f Te

sts

per

ED

P

rese

nta

tio

n

Troponin EUC Automated Diff

LFT PT/INR/

APTT

00.20.40.60.8

11.21.41.61.8

ADEF1 1 1 11 1 11 2 2 2 22 2 2 2 3 32 33 3 3 3 4 44 44 4 5 4 7 65 56 4 55

Hospital ED

Rank

2008

2011

DRG: Chest Pain (F74Z)Image: FreeDigitalPhotos.net / nokhoog_buchachon

So, what does it mean?

Thank You

This project was funded by a grant from:

Australian Government

Department of Health and Ageing,

Quality Use of Pathology Program.

Email: e.vecellio@unsw.edu.au

www.aihi.unsw.edu.au

Centre for Health Systems and Safety Research

Examination of changes in pathology tests ordered by Diagnosis-Related Group (DRGs) following CPOE introduction

E Vecellio 1, A Georgiou 1, G Toouli 1, A Eigenstetter 2, L Li 1, R Wilson 2, JI Westbrook 1

1 Centre for Health Systems and Safety Research, University of New South Wales, Sydney, NSW2 South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW

Results

2008 2009 2010 20110

2

4

6

8

10

12

14

16

18

20

Tracheostomy

Rehabilitation

Haemodialysis

Respiratory In-fection

Chest Pain

Overall (Top-5 DRGs)

Mea

n N

um

ber

of

Test

s p

er I

np

atie

nt

per

Day

EMR@6 HospitalsEMR@3