Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Thompson PJ [original query] |
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Evaluating a mobile application for improving clinical laboratory test ordering and diagnosis
Meyer AND , Thompson PJ , Khanna A , Desai S , Mathews BK , Yousef E , Kusnoor AV , Singh H . J Am Med Inform Assoc 2018 25 (7) 841-847 Objective: Mobile applications for improving diagnostic decision making often lack clinical evaluation. We evaluated if a mobile application improves generalist physicians' appropriate laboratory test ordering and diagnosis decisions and assessed if physicians perceive it as useful for learning. Methods: In an experimental, vignette study, physicians diagnosed 8 patient vignettes with normal prothrombin times (PT) and abnormal partial thromboplastin times (PTT). Physicians made test ordering and diagnosis decisions for 4 vignettes using each resource: a mobile app, PTT Advisor, developed by the Centers for Disease Control and Prevention (CDC)'s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC); and usual clinical decision support. Then, physicians answered questions regarding their perceptions of the app's usefulness for diagnostic decision making and learning using a modified Kirkpatrick Training Evaluation Framework. Results: Data from 368 vignettes solved by 46 physicians at 7 US health care institutions show advantages for using PTT Advisor over usual clinical decision support on test ordering and diagnostic decision accuracy (82.6 vs 70.2% correct; P < .001), confidence in decisions (7.5 vs 6.3 out of 10; P < .001), and vignette completion time (3:02 vs 3:53 min.; P = .06). Physicians reported positive perceptions of the app's potential for improved clinical decision making, and recommended it be used to address broader diagnostic challenges. Conclusions: A mobile app, PTT Advisor, may contribute to better test ordering and diagnosis, serve as a learning tool for diagnostic evaluation of certain clinical disorders, and improve patient outcomes. Similar methods could be useful for evaluating apps aimed at improving testing and diagnosis for other conditions. |
Opportunities to enhance laboratory professionals' role on the diagnostic team
Taylor JR , Thompson PJ , Genzen JR , Hickner J , Marques MB . Lab Med 2016 48 (1) 97-103 BACKGROUND: The 2015 Institue of Medicine report Improving Diagnosis in Health Care highlighted that diagnostic errors cause patient harm and that improvement in the diagnostic process requires better collaboration among physicians and laboratory professionals. The purpose of this study is to understand why physicians do not contact laboratory professionals when facing diagnostic challenges and identify opportunities for laboratory professionals to become more recognized members of the clinical care team. METHODS: A random sample of 31,689 physicians from the American Medical Association Masterfile were surveyed about diagnostic challenges in laboratory test ordering and results interpretation, solutions to these challenges, and interactions with laboratory professionals. RESULTS: We received responses from 1768 physicians (5.6%). When faced with diagnostic challenges, they reported using electronic resources because they find it difficult and time-consuming to contact the laboratory. Only 20% had an effective way to access laboratory professionals, mostly seeking help for logistical but less for clinical issues. Continuing medical education, professional articles, and updates from the laboratory were helpful. CONCLUSIONS: Laboratory professionals have an opportunity to play a greater role in the diagnostic process by becoming active members of the clinical care team, beyond providing results. This study provides strategies to increase laboratory professionals' role in the diagnostic process. |
Primary care physicians and the laboratory: now and the future
Marques MB , Hickner J , Thompson PJ , Taylor JR . Am J Clin Pathol 2014 142 (6) 738-40 Steven Kroft,1 past president of the American Society for Clinical Pathology, challenged the laboratory community at the beginning of 2014 to remember 10 things that we must do to face and thrive in the future. His premise: the landscape in health care is changing dramatically, and the laboratory is right in the middle and must adapt. His list included the following: (10) “Be smart about your human resources.” (9)“Get lean.” (8) “Take charge of test utilization.” (7) “Take up permanent residence in the patient-centered medical home.” (6) “Create true value.” (5) “Locate your inner informatician.” (4) “Get out of the lab.” (3) “Quality is not optional.” (2) “Never, EVER forget who our final customers are.” (1) “Don’t fight the future. Embrace it.” A common theme is that laboratorians (pathologists and nonpathologists) must add value to the health care team by providing high-quality and cost-effective results, optimizing utilization of the clinical laboratory, and being visible to be relevant. Serendipitously, Kroft’s advice directly relates to findings of a survey of primary care physicians (PCPs) published soon thereafter in the Journal of the American Board of Family Medicine.2 |
Primary care physicians' challenges in ordering clinical laboratory tests and interpreting results
Hickner J , Thompson PJ , Wilkinson T , Epner P , Sheehan M , Pollock AM , Lee J , Duke CC , Jackson BR , Taylor JR . J Am Board Fam Med 2014 27 (2) 268-74 BACKGROUND: The number and complexity of clinical laboratory tests is rapidly expanding, presenting primary care physicians with challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests. The objective of this study was to identify challenges primary care physicians face related to diagnostic laboratory testing and solutions they believe are helpful and available to them. METHODS: In this study, sponsored by the Centers for Disease Control and Prevention, a random sample of general internal medicine and family medicine physicians from the American Medical Association Masterfile were surveyed in 2011. RESULTS: 1768 physicians (5.6%) responded to the survey. Physicians reported ordering diagnostic laboratory tests for an average of 31.4% of patient encounters per week. They reported uncertainty about ordering tests in 14.7% and uncertainty in interpreting results in 8.3% of these diagnostic encounters. The most common problematic challenges in ordering tests were related to the cost to patients and insurance coverage restrictions. Other challenges included different names for the same test, tests not available except as part of a test panel, and different tests included in panels with the same names. The most common problematic challenges in interpreting and using test results were not receiving the results and confusing report formats. Respondents endorsed a variety of information technology and decision support solutions to improve test selection and results interpretation, but these solutions were not widely available at the time of the survey. Physicians infrequently sought assistance or consultation from laboratory professionals but valued these consultations when they occurred. CONCLUSIONS: Primary care physicians routinely experience uncertainty and challenges in ordering and interpreting diagnostic laboratory tests. With more than 500 million primary care patient visits per year, the level of uncertainty reported in this study potentially affects 23 million patients per year and raises significant concerns about the safe and efficient use of laboratory testing resources. Improvement in information technology and clinical decision support systems and quick access to laboratory consultations may reduce physicians' uncertainty and mitigate these challenges. |
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