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Evaluation of thyroid test utilization through analysis of population-level data.

Jasmine Gill1, Vilte E Barakauskas1, Dylan Thomas1

  • 1.

Clinical Chemistry and Laboratory Medicine
|March 18, 2017
PubMed
Summary

Inappropriate thyroid testing, including excessive frequency and suboptimal reflex cutpoints, contributes to healthcare costs. Optimizing testing patterns and reflex thresholds can improve utilization and reduce waste.

Keywords:
free T3free T4reflex algorithmtest utilizationthyroidthyroid-stimulating hormone

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Endocrinology

Background:

  • Inappropriate laboratory test utilization leads to increased healthcare costs and unnecessary patient testing.
  • Thyroid-stimulating hormone (TSH) is the recommended first-line test for thyroid dysfunction.
  • Evaluating thyroid test patterns, frequencies, and reflex cutpoints is crucial for optimizing utilization.

Purpose of the Study:

  • To evaluate thyroid test utilization in Northern Alberta.
  • To analyze testing patterns, frequencies, and reflex cutpoints for thyroid function tests.
  • To identify factors contributing to inappropriate thyroid test utilization.

Main Methods:

  • Retrospective analysis of 752,217 thyroid test requests from January to December 2014.
  • Categorization of test requests as appropriate or potentially inappropriate based on guidelines.
  • Calculation of testing frequencies and generation of ROC curves for TSH reflex cutpoints.

Main Results:

  • Approximately 10% of test requests were potentially inappropriate.
  • Free thyroxine (FT4) and free triiodothyronine (FT3) with TSH comprised 59% of inappropriate requests.
  • Excessive testing frequencies were noted in 869 patients; adjusted TSH cutpoints improved FT4 identification.

Conclusions:

  • Questionable testing patterns, excessive testing frequencies, and suboptimal reflexive testing cutpoints contribute to inappropriate thyroid test utilization.
  • Optimizing TSH reflex cutpoints can enhance the specificity of identifying low FT4 levels.
  • Addressing these factors can lead to more appropriate and cost-effective thyroid test utilization.