Prothrombin Time and Activated Partial Thromboplastin Time Testing: A Comparative Effectiveness Study in a Million-Patient Sample

Background A substantial fraction of all American healthcare expenditures are potentially wasted, and practices that are not evidence-based could contribute to such waste. We sought to characterize whether Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) tests of preoperative patients are used in a way unsupported by evidence and potentially wasteful. Methods and Findings We evaluated prospectively-collected patient data from 19 major teaching hospitals and 8 hospital-affiliated surgical centers in 7 states (Delaware, Florida, Maryland, Massachusetts, New Jersey, New York, Pennsylvania) and the District of Columbia. A total of 1,053,472 consecutive patients represented every patient admitted for elective surgery from 2009 to 2012 at all 27 settings. A subset of 682,049 patients (64.7%) had one or both tests done and history and physical (H&P) records available for analysis. Unnecessary tests for bleeding risk were defined as: PT tests done on patients with no history of abnormal bleeding, warfarin therapy, vitamin K-dependent clotting factor deficiency, or liver disease; or aPTT tests done on patients with no history of heparin treatment, hemophilia, lupus anticoagulant antibodies, or von Willebrand disease. We assessed the proportion of patients who received PT or aPTT tests who lacked evidence-based reasons for testing. Conclusions This study sought to bring the availability of big data together with applied comparative effectiveness research. Among preoperative patients, 26.2% received PT tests, and 94.3% of tests were unnecessary, given the absence of findings on H&P. Similarly, 23.3% of preoperative patients received aPTT tests, of which 99.9% were unnecessary. Among patients with no H&P findings suggestive of bleeding risk, 6.6% of PT tests and 7.1% of aPTT tests were either a false positive or a true positive (i.e. indicative of a previously-undiagnosed potential bleeding risk). Both PT and aPTT, designed as diagnostic tests, are apparently used as screening tests. Use of unnecessary screening tests raises concerns for the costs of such testing and the consequences of false positive results

Landscape Analysis: What Are the Forefronts of Change in the US Hospitals?

Compilation of information is increasingly becoming more important for health organizations from financial and time aspects. By methodical study of adaptive systems, healthcare organizations can gain new insights of burdensome issues within the organization as well as healthcare delivery management. These actions have become more important with the changes in the healthcare environment in the last couple of decades where several external entities have impacts on healthcare organizations directly and/or indirectly. One of the most onerous tasks ahead of organizations is to anticipate these changes and prepare for them. Knowing the external environment can be the key to leading a successful and competitive health system. However, identifying and behaving toward all the external changes pose great time and resource challenges for organizations. Health organizations can posit the question of “what are the current external changes that have the power to affect them?” This study will take a look into emerging extrinsic changes for the US healthcare environment in different areas. A literature review will be performed in order to pinpoint the different contemporary change perspectives and their sub-criteria. In order to better illustrate these issues, Ishikawa diagram (cause-and-effect diagram) is used in this study