4 Tests-to-Target

National High Value Performance Improvement Campaign

With the mission of delivering measurable improvements in health care value, the High Value Practice Academic Alliance announces a new campaign entitled “4 Tests to Target“. All medical centers are invited to participate, by making a commitment to reduce unnecessary ordering of 4 lab tests have been safely decreased in many institutions without compromising patient care quality or safety. Join the charge to demonstrate accountability for value-based care. Together we can move the needle!

How to participate:

  1. Register your medical center using form below
  2. Download the educational resources to guide reduction of each test
  3. Measure baseline ordering volume & appropriateness
  4. Implement interventions to improve ordering appropriateness
  5. Measure post-implementation ordering volume & appropriateness
  6. Submit aggregate level data to the HVPAA national database
Folic Acid

Rationale: Folate testing has no utility in Western countries because of ubiquitous folic acid fortification. Additionally, it is not reliable for identifying folate deficiency. For the rare patient suspected of having folate deficiency, treating with folic acid is more cost effective than testing.

Educational resources:

Clinical decision support message:  Folate deficiency occurs in <1% of the US population. Consider empirically treating high-risk patients with folic acid.

Fecal Occult Blood Testing in Inpatients

Rationale: Fecal occult blood testing is not reliable to detect GI bleeding, false-positives occur in up to 10% of patients and false-negatives in up to 50%. The test is designed to screen outpatients for colorectal cancer and should not be used to guide the management of inpatients with suspected GI bleeding.

Educational resources:

Clinical decision support intervention: Remove FOBT from inpatient order entry.

CK-MB in Suspected Acute Coronary Syndrome

Rationale: Diagnosing patients with acute coronary syndrome (ACS) is crucial to initiating treatment earlier. In addition, knowing which patients do not have acute coronary syndrome reduces unnecessary downstream testing. While CK-MB was traditionally used to diagnose ACS, troponin has much better test performing characteristics for accurate diagnosis and is the gold standard according to American College of Cardiology guidelines.

Educational resources:

Clinical decision support intervention: Remove CK-MB from Emergency Department order entry.

Amylase in Acute Pancreatitis

Rationale: The most sensitive and specific test for acute pancreatitis is lipase. Addition of amylase adds no incremental diagnostic efficacy. Furthermore, repeat testing should be avoided after diagnosis of acute pancreatitis.

Educational resources:

Clinical decision support intervention:  Remove amylase from Emergency Department order sets.

Registration: [ninja_form id=13]