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An algorithmic approach to thyroid function testing in a managed care setting. 3-year experience

C S Feldkamp1, J L Carey

  • 1Department of Pathology, Henry Ford Hospital, Detroit, MI 48202, USA.

American Journal of Clinical Pathology
|January 1, 1996
PubMed
Summary
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A new thyroid testing algorithm significantly reduces unnecessary tests and costs. This approach improves efficiency by focusing on patients needing further thyroid function evaluation.

Area of Science:

  • Clinical Chemistry
  • Endocrinology
  • Health Services Research

Background:

  • Thyroid function testing is crucial for diagnosing and managing endocrine disorders.
  • Previous thyroid testing protocols could lead to unnecessary procedures and increased healthcare costs.
  • The need for efficient and cost-effective diagnostic algorithms in large patient populations is well-established.

Purpose of the Study:

  • To evaluate the impact of a directed thyroid testing algorithm (DRTSH) on test utilization, cost, and efficiency.
  • To assess physician acceptance and the effectiveness of the DRTSH in a large outpatient setting.

Main Methods:

  • Implementation of a directed thyrotropin (TSH) and directed thyroid testing algorithm (DRTSH) in 1990.
  • The algorithm initiated with sensitive TSH measurement, followed by free thyroid index (T4 x Resin Uptake Ratio) if TSH was outside the normal range (< 0.4 or > 5.5 mU/L).

Related Experiment Videos

  • Evaluation conducted in a large, predominantly outpatient, prepaid healthcare population.

    • Main Results:

    • High physician acceptance (>90%) of the DRTSH was observed three years post-implementation.
    • Significant reductions in overall thyroid test utilization were achieved.
    • Decreased test turnaround times and demonstrable cost savings were reported.

    Conclusions:

    • The directed thyroid testing algorithm (DRTSH) is an effective strategy for optimizing thyroid function testing in outpatient settings.
    • This algorithm successfully reduces unnecessary testing, leading to improved resource allocation and significant cost reductions.
    • The DRTSH demonstrates high physician acceptance and contributes to more efficient healthcare delivery.