Guidance on effective testing for top DRGs.

Guidance on effective testing for top DRGs

An important contribution to better laboratory utilization comes from the College of American Pathologists, which has issued guidelines to help clinicians and pathologists achieve effective testing. The guidelines are lists of tests for 24 of the 25 Diagnosis Related Groups that account for as many as 80 per cent of U.S. hospital admissions.

Tests associated with each DRG are divided into three categories. The first category, basic tests, have been found to be consistently required for management of diseases and complications within the DRG. It's expected that nearly all patients in the diagnostic group will have had these tests ordered for them. The second category, common tests, are frequently, but not always, necessary for patients in the DRG. The third category, less common tests, are not needed as often for these patients. Figure I shows the basic, common, and less common tests for DRG 132, atherosclerosis.

There's really a fourth category, too, consisting of unlisted tests. In this regard, tests are often required to exclude alternatives to the final diagnosis selected. And while the DRG system only allows a single principal discharge diagnosis per patient, the CAP notes that "many tests apparently unrelated to a particular DRG may yet have great relevance to the clinical management of a given patient.'

On the other hand, even basic tests may not have to be performed for every patient. Clinicians might skip lab procedures that were part of a recent preadmission workup, for example.

These and other considerations are discussed in "Effective Laboratory Testing,' an introduction that is essential background for proper use of the DRG test lists. In particular, the CAP emphasizes such matters as testing policies and criteria that individual labs and medical staffs should determine for themselves (covering microscopic exams in urinalysis, to cite one area); appropriate substitutions for tests on the DRG lists; and commonly ordered procedures that are not listed because they are better handled on an outpatient basis.

The introduction suggests ways to curb wasteful testing and improve laboratory utilization. It also makes a strong statement about the cost-effectiveness of performing "an initial group of highly automated and inexpensive tests followed by sequential testing, often utilizing the initial specimen.'

That's an area where the CAP--or possibly some other organization --can be of further valuable assistance by providing algorithms of follow-up tests to rule out or confirm diagnoses. The College should consider this approach as part of its plan to publish test guidelines for all DRGs.

But for now, we have an important document that is available in reasonable quantitities at no cost from: DRG Guidelines, College of American Pathologists, 5202 Old Orchard Road, Skokie, Ill. 60077. I urge you to write in for the guidelines if your laboratory has not already obtained them.

Table: Figurel Tests for DRG 132, atherosclerosis