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How can you use utilization management to ensure proper laboratory test use?

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Laboratory tests are essential for diagnosing, monitoring, and treating various health conditions. However, they can also be costly, time-consuming, and sometimes unnecessary or inappropriate. Utilization management (UM) is a strategy to optimize the use of laboratory tests by ensuring that they are ordered, performed, and interpreted according to evidence-based guidelines and best practices. In this article, you will learn how you can use UM to ensure proper laboratory test use in your healthcare organization.

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Jeremy Wigginton, MD, MBA, FAAFP

Chief Medical Officer & Physician Executive leading strategy, transformational change and business evolution using…

1 What is utilization management?

UM is a process of evaluating the appropriateness, necessity, and quality of healthcare services, including laboratory tests, based on established criteria and standards. UM aims to improve patient outcomes, reduce waste, and control costs. UM can be applied at different levels, such as pre-test, post-test, or retrospective review, and by different stakeholders, such as providers, payers, or patients. UM can also involve various tools and methods, such as clinical decision support systems, prior authorization, feedback reports, or audits.

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2 Why is utilization management important for laboratory tests?

Laboratory tests account for a significant portion of healthcare spending and influence many clinical decisions. However, studies have shown that many laboratory tests are overused, underused, or misused, leading to poor quality of care, patient harm, and unnecessary expenses. Some of the reasons for inappropriate laboratory test use include lack of knowledge, uncertainty, defensive medicine, patient demand, or habit. UM can help address these issues by providing guidance, education, feedback, and incentives to ensure that laboratory tests are ordered and used according to the best available evidence and the patient's needs and preferences.

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Jeremy Wigginton, MD, MBA, FAAFP

Chief Medical Officer & Physician Executive leading strategy, transformational change and business evolution using data-driven decision making and Lean principles.
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Another important perspective is to consider the wholistic care that is being provided in context with the testing. Such as with some bio-marker and genetic testing, there is often a complex care and treatment model encompassing that testing. A wholistic strategy should be considered, not simply a stand alone UM/UR program.

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3 How can you implement utilization management for laboratory tests?

Implementing UM for laboratory tests requires a systematic and collaborative approach that involves multiple steps and stakeholders. To begin, you should assess the current state of laboratory test use and identify the gaps and opportunities for improvement. You can use data sources such as electronic health records, claims, or laboratory information systems to analyze the patterns, trends, and variations of laboratory test use across your organization. Additionally, you should define the goals and objectives of UM for laboratory tests and align them with your organization's mission, vision, and values. Selecting the appropriate UM tools and methods for laboratory tests is also important, as well as engaging and educating the stakeholders involved in laboratory test use and UM. Finally, you should implement, monitor, and evaluate the UM tools and methods for laboratory tests and make adjustments as needed. Utilizing a plan-do-study-act (PDSA) cycle or a similar quality improvement methodology can help you test, refine, and scale up the UM tools and methods for laboratory tests. By following these steps, you can ensure that UM for laboratory tests is effective, efficient, and successful.

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Belal Abul-Asal

Head Quality Monitoring and Evaluation at King Abdullah University Hospital
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It will be easier to say that implementing evidence-based practices does ensure the necessity and appropriateness of any laboratory test. Also, when you computerise these practices, HIS will not allow requesting some i appropriate tests.

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4 What are the benefits and challenges of utilization management for laboratory tests?

UM for laboratory tests can offer many benefits to healthcare organizations, such as improving the quality and safety of care, enhancing the patient experience, and increasing the efficiency and productivity of the system. Additionally, it can save costs and resources by avoiding unnecessary or inappropriate laboratory tests. However, UM for laboratory tests can also present some challenges. Implementing and maintaining the UM tools and methods may require time, effort, and investment. Additionally, there may be resistance or skepticism from stakeholders who perceive UM as a threat. Furthermore, balancing the standardization and customization of UM for laboratory tests to ensure that they are evidence-based yet flexible can be difficult. Finally, dealing with the complexity and uncertainty of clinical practice and laboratory science may limit the applicability and validity of UM for laboratory tests.

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5 How can you innovate and improve utilization management for laboratory tests?

UM for laboratory tests is a dynamic and evolving process that requires continuous learning and improvement. To innovate and improve UM for laboratory tests, you should stay up to date with the latest evidence, guidelines, and best practices. Additionally, seek feedback from stakeholders and leverage technology and data to enhance the functionality, usability, and accessibility of your UM tools. Furthermore, collaborate and network with other healthcare organizations or experts who are implementing or researching UM for laboratory tests and share your knowledge.

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6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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How can you use utilization management to ensure proper laboratory test use?

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1 What is utilization management?

2 Why is utilization management important for laboratory tests?

3 How can you implement utilization management for laboratory tests?

4 What are the benefits and challenges of utilization management for laboratory tests?

5 How can you innovate and improve utilization management for laboratory tests?

6 Here’s what else to consider

Healthcare Management

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How can you use utilization management to ensure proper laboratory test use?

1

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3

4

5

6

1 What is utilization management?

2 Why is utilization management important for laboratory tests?

3 How can you implement utilization management for laboratory tests?

4 What are the benefits and challenges of utilization management for laboratory tests?

5 How can you innovate and improve utilization management for laboratory tests?

6 Here’s what else to consider

Healthcare Management

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