Screening for clinical laboratory errors with Medicare claims data: results for digoxin.
A statistical model is demonstrated for finding outpatient clinical laboratories having high frequencies of bad patient outcomes, after testing, that may indicate testing errors. A sample of Medicare Part A and Part B claims for 30,685 digoxin tests for 1985 through 1987 was analyzed. Deaths or digoxin-related hospitalizations within 14 days of digoxin testing are defined as "adverse events" potentially influenced by test information. Approximately 3.3% of digoxin tests were followed by adverse events with two-thirds resulting in hospitalization or death. Adverse events were (a) lower in states with stronger laboratory regulations, (b) 15% higher whenever the site of testing switched, (c) unrelated to testing in low volume physician office laboratories, and (d) unrelated to frequency of digoxin testing in previous 6 months. Results a and b are consistent with findings for prothrombin testing but c and d are not. Differences are consistent with technical characteristics of the tests.
Winkelman
J W
JW
University of Alabama, Birmingham 35294-2010, USA.
Mennemeyer
S T
ST
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D003951:Diagnostic Errors; D004077:Digoxin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D007753:Laboratories / Q000592:standards*; D008297:Male; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data*; D015233:Models, Statistical; D016017:Odds Ratio; D012044:Regression Analysis; D014481:United States
D000889:Anti-Arrhythmia Agents; D004077:Digoxin