Does Provider Specialty Matter?

OBJECTIVES: Multiple practice guidelines discourage indiscriminate use of broad panels of allergen-specific IgE (sIgE) tests due to increased risk of false positives and misinterpretation of results. We provide an analytical framework to identify specialty-specific differences in ordering patterns and effectiveness, which can be used to improve test utilization. METHODS: Test results from a tertiary pediatric hospital were analyzed by ordering specialty to evaluate size of allergen workups. Positivity rates were analyzed to determine effectiveness in selecting tests with high positive pretest probabilities. Laboratory test menu components were also evaluated. RESULTS: Our findings demonstrate 29% of sIgE tests are ordered as part of broad workups (>20 sIgE tests/date of service) contrary to the recommended testing approach. Detailed descriptions of ordering patterns and positivity rates are provided. CONCLUSIONS: This study provides a framework for using a cross-sectional analytical approach to assess test utilization patterns and evaluate components of laboratory testing menus.

Evaluation of an alternative care provider clinic for severe sleep-disordered breathing: a study protocol for a randomised controlled trial.

INTRODUCTION: Despite the high prevalence of sleep-disordered breathing (SDB) and the significant health consequences associated with untreated disease, access to diagnosis and treatment remains a challenge. Even patients with severe SDB (severe obstructive sleep apnoea or hypoventilation), who are at particularly high risk of adverse health effects, are subject to long delays. Previous research has demonstrated that, within a sleep clinic, management by alternative care providers (ACPs) is effective for patients with milder forms of SDB. The purpose of this study is to compare an ACP-led clinic (ACP Clinic) for patients with severe SDB to physician-led care, from the perspective of clinical outcomes, health system efficiency and cost. METHODS AND ANALYSIS: The study is a randomised, controlled, non-inferiority study in which patients who are referred with severe SDB are randomised to management by a sleep physician or by an ACP. ACPs will be supervised by sleep physicians for safety. The primary outcome is positive airway pressure (PAP) adherence after 3 months of therapy. Secondary outcomes include: long-term PAP adherence; clinical response to therapy; health-related quality of life; patient satisfaction; healthcare usage; wait times from referral to treatment initiation and cost-effectiveness. The economic analysis will be performed using the perspective of a publicly funded healthcare system. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Conjoint Health Research Ethics Board (ID: REB13-1280) at the University of Calgary. Results from this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT02191085; Pre-results.

[Availability and integration of palliative medicine at certified lung cancer centers]. / Verfügbarkeit und Integration von Palliativmedizin an zertifizierten Lungenkrebszentren.

BACKGROUND: It is the aim of the certification system for Organ Cancer Centers of the German Cancer Society to ensure that oncology patients receive therapy meeting high quality standards. Lung cancer patients require comprehensive palliative care due to their high symptom load. The purpose of the present study was to identify the existing palliative care structures at 39 certified lung cancer centers. METHODS: The survey tool used was an 18-question questionnaire sent by surface mail to the respective centers. RESULTS: A total of 30 centers took part in the survey. A physician with the additional qualification 'palliative care' was employed at 21 of the centers, a certified palliative care nurse worked at 24 centers. A palliative care unit was available at 9 centers. The cited obstacles to the delivery of palliative care included a shortage of qualified palliative care staff, a lack of refinancing, and the concern that the suggestion of palliative care might cause negative emotions in the respective patients. CONCLUSIONS: Certified lung cancer centers had a wide range of palliative care structures. Openness to and interest in extending existing palliative care services were most commonly identified. A number of serious obstacles in achieving this goal were nevertheless cited.