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Fact and Stats

An electronic message sent to physicians the moment they ordered a blood test for elderly patients reduced unnecessary use of the test that is often false-positive for the elderly, according to a paper published in the November edition of American Journal of Managed Care.

The D-dimer test, combined with a clinical risking algorithm, can help in the diagnosis of deep vein thrombosis (blood clots in veins, otherwise known as DVTs) and pulmonary embolism (blood clots in the lungs). The risk of developing a blood clot in the venous circulation increases with age, and yet the overall accuracy of the D-dimer test worsens as patients get older, and is only 35 percent for patients 65 years of age and over. This can result in numerous false-positives and additional, unnecessary testing.

This study is among the first to look at the effectiveness of an electronic alert for a specific condition in a specific patient population. The randomized trial of 223,877 patient visits for patients 65 years of age and over, and 564,264 patient visits for patients under 65 years of age, was implemented in eight primary care clinics within the Kaiser Permanente health care system in Colorado, each with at least 3,000 patients aged 65 years or older.

Physicians received an alert in Kaiser Permanente’s electronic health record, Kaiser Permanente HealthConnect®, when ordering a D-dimer test for patients aged 65 and up. The alert explained the inaccuracy of the test for this age group and suggested using a radiological test as appropriate. As a result, the rate of D-dimer tests for patients over 65 decreased significantly from 5.02 to 1.52 per 1,000 patient visits, a relative reduction of D-dimer orders of 69.7%. This decrease was maintained throughout the study period and the result was similar when the control group later received the alert.

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Source: Real-time Physician Electronic Alerts Reduce Unnecessary Blood Testing in Elderly Patients.

Date: November 5, 2010

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This entry was posted on Wednesday, November 10th, 2010 at 2:32 pm and is filed under Longwoods Online.