Utilization of renal function and iron status laboratory test investigations in Eastern Health

Thorburn, Jack R. (2019) Utilization of renal function and iron status laboratory test investigations in Eastern Health. Masters thesis, Memorial University of Newfoundland.

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Abstract

Introduction: Healthcare spending in Canada reached 219.1 billion dollars in 2015. Unnecessary laboratory test investigations have been well documented in many countries, making it an area of interest in order to reduce costs, improve care and ultimately improve the performance of the health care system. The use of serum urea is unnecessary to evaluate kidney function in stable patients as serum creatinine has better specificity and no decrease in sensitivity. Therefore, we examined the use of serum urea in the community of a regional health authority. Ferritin is a good test of iron status and indicated in anemic patients, particularly when mean corpuscular volume/mean corpuscular hemoglobin levels are low. Therefore, we examined the use of iron status tests in the community to determine the degree of under-utilization in the patients likely to have iron deficient anemia and of over-utilization in patients with normal hemoglobin and blood indices. Methods: We performed a retrospective analysis of Eastern Health’s laboratory electronic database to investigate patterns of laboratory test utilization for two specific bundles of tests: (1) serum creatinine and serum urea; (2) hemoglobin (hgB), ferritin and iron saturation. Laboratory tests were examined for a 6-month period in 2014 (bundle 1) and a 12-month period (bundle 2) throughout 2013-2014. Test utilization is described by age, sex, patient type (inpatient/outpatient), submitting physician specialty and test result. Results: 227, 092 serum creatinine and 218, 289 serum urea tests were ordered for all patients within the Eastern Health Region during the 6-month period. 96.8 % (n=211, 279) serum urea tests were ordered in the same draw as serum creatinine. 64.6% (n=141,112) serum urea tests were ordered in the same draw as serum creatinine for outpatients. General practitioners elicited the highest rate of serum urea tests (52.5% of total), followed by the internal medicine specialty. 69.3% (n=62, 274) of coupled serum creatinine and serum urea laboratory investigations ordered by general practitioners for outpatients elicited normal results for both tests. High volumes of hemoglobin (n=450, 792) and iron status tests (ferritin; n=86,293, iron saturation; n=23,415) were ordered within the 12-month period. General practitioners elicited the highest ordering for all three tests for outpatients. 89.6% (n=55,595) of iron tests requested by general practitioners for nonanemic outpatients (first Hgb) produced a normal result in the 12-month period. 44.9% (n=136) of females (≤ 50 years of age) with anemia did not undergo iron testing within 1-year of the first documentation of the anemia by a general practitioner. Conclusion: Serum urea and iron testing may be areas of interest for the improvement of utilization of health care resources within the Eastern Health Region. Information contained in this thesis may be used as a guiding tool for decision makers in the development of interventions to improve test-ordering behaviours without compromising patient quality of care.

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