title: Evaluation of a protocol to control utilization of B-type natriuretic peptide testing.
abstract: The Veterans Affairs (VA) Boston Healthcare System, Boston, MA, instituted a protocol limiting the number of B-type natriuretic peptide (BNP) assays to 1 per hospitalization or outpatient visit and requiring approval of the cardiology service for more than 1 because of a 3-fold monthly increase in BNP testing. Effectiveness of this protocol was assessed by studying BNP utilization for 6-month periods before and after institution of the protocol. Before: 1,886 assays in 752 patients; mean BNP assays per patient, 2.5; direct reagent cost, $33,948; 1 BNP assay in 57.3% (431) of patients; 321 patients with multiple and 204 patients with serial BNP requests. After: 782 assays (-58.5%) in 593 patients (-21.1%); mean BNP assays per patient, 1.3 (-48.0%); direct reagent cost, $14,076 (-58.5%); 1 BNP assay in 81.1% (481) of patients; 112 patients with multiple and 24 patients with serial BNP requests (-88.2%). The emergency department was the source of BNP assays in 15.4% of requests before compared with 58.1% after introduction of the protocol. The protocol with slight modifications has been adopted by other VA medical centers in New England and may serve as a model for other medical facilities seeking to control BNP utilization.
authors.affiliation: Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, USA.
authors.forename: Gifford
authors.initials: G
authors.lastname: Lum
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D017410:Practice Guidelines as Topic; D014600:Utilization Review; D014728:Veterans
chemical_list: D020097:Natriuretic Peptide, Brain