Patterns of Laboratory Testing Utilization Among Uveitis Specialists

Abstract

Purpose: To examine the range of practice in laboratory testing utilization among a subset of uveitis specialists using a scenario-based survey.

Design: Cross-sectional survey.

Methods: A web-based survey consisting of 13 patient scenarios was presented to the Executive Committee and Trustees of the American Uveitis Society. The participants were allowed to choose preferred testing in a free-form manner. The patterns of test utilization were studied and the cost of the testing was calculated based on Noridian Medicare reimbursal rates for Seattle, Washington.

Results: Nearly all providers recommended some testing for all scenarios. Forty-five different tests, including laboratory investigations and imaging and diagnostic procedures, were ordered. The mean number of tests ordered per scenario per provider was 5.47 ± 2.71. There was limited consensus among providers in test selection, with most tests in each scenario ordered by fewer than half of the providers. Average cost of testing per scenario per provider was $282.80, with 4 imaging tests (fluorescein angiography, magnetic resonance imaging, chest radiograph, and chest computed tomography) together contributing 59.9% of the total testing costs.

Conclusions: Uveitis specialists have a high rate of laboratory testing utilization in their evaluation of new patients. There is substantial variability in the evaluations obtained between providers. Imaging tests account for the majority of evaluation cost. The low agreement on specific testing plans suggests need for evidence-based practice guidelines for the evaluation of uveitis patients.

FIGURE 1

Distribution of the total number of ordered tests per scenario by each provider.

FIGURE 2

Frequency of test orders across all scenarios by provider. Bottom row shows average percentage of cases in which an individual test was ordered by all 11 providers. Provider numbers (1–11) are designated on right y-axis. Test abbreviations: Syphilis ab = fluorescent treponemal antibody (ab) absorption test, microhemagglutination assay, treponema pallidum particle agglutination; CXR = chest radiograph; CBC = complete blood count; RPR = rapid plasma reagin, venereal disease research laboratory test; FA = fluorescein angiography; CMP = complete metabolic panel; ACE = angiotensin-converting enzyme; OCT = ocular coherence tomography; PPD = purified protein derivative skin test; ANA = antinuclear antibody; ESR = erythrocyte sedimentation rate; UA = urinalysis; ANCA = antineutrophil cytoplasmic ab; RF = rheumatoid factor; anti-CCP, cyclic citrullinated peptide ab; CRP = C-reactive protein; ICG = indocyanine green angiography; HTLV = human T-cell lymphotropic virus; ERG = electroretinogram; HVF = Humphrey visual field; A1C = hemoglobin A1C; anti-RNP = anti-ribonucleoprotein ab; antiSS = anti–Sjögren syndrome ab; GVF = Goldmann visual field.