Centre for Health Systems and Safety Research
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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, NSW 2 South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW
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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. - PowerPoint PPT Presentation
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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 stayAncillary service utilisationNursing 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
umbe
r of
Test
s pe
r Inp
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
umbe
r of
Test
s pe
r Inp
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 of
Tes
ts
per E
D
Pres
enta
tion
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: [email protected]
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
RehabilitationHaemodialysis
Respiratory In-fectionChest Pain
Overall (Top-5 DRGs)
Mea
n N
umbe
r of
Test
s pe
r Inp
atie
nt
per D
ay
EMR@6 HospitalsEMR@3
