Optimization of Advanced Molecular Genetic Testing Utilization in Hematopathology: A Goldilocks Approach to Bone...

Area of Science:

• Hematopathology
• Clinical Pathology
• Health Informatics

Background:

• Hematopathology diagnostic testing often involves complex and expensive molecular and cytogenetic assays.
• Current test ordering practices can lead to significant overutilization and omission of crucial tests, impacting cost and diagnostic yield.
• The need for cost-effective and efficient diagnostic strategies in pathology is paramount.

Purpose of the Study:

• To evaluate the effectiveness of an algorithmic testing approach in hematopathology.
• To assess the impact of standardized ordering protocols (SOPs) on test selection and cost-efficiency.
• To determine if algorithmic testing improves diagnostic accuracy while reducing unnecessary expenses.

Main Methods:

• Development and implementation of SOPs for 17 disease categories within a decision support application.
• Retrospective analysis of 460 cases before algorithmic testing implementation.
• Prospective analysis of 109 cases after algorithmic testing implementation, including data from a community satellite site.

Main Results:

• Retrospective data showed 38.3% of tests were overordered and 30.8% of recommended tests were omitted.
• Prospective data demonstrated a significant improvement: only 1.2% of tests were overordered and 7.6% omitted (P < .001).
• Potential annualized savings of over $1.3 million were identified due to reduced overordering, with minimal loss of informative results.

Conclusions:

• Implementation of SOPs dramatically improved hematopathology test ordering practices.
• Algorithmic testing effectively minimized unnecessary ancillary tests, reducing costs without compromising key diagnostic information.
• This approach offers a cost-effective solution for optimizing diagnostic testing in hematopathology.