From 3048a7105cd7506e7a3a6d4e45a89acb2699be6d Mon Sep 17 00:00:00 2001 From: Kyle Belanger Date: Thu, 1 Sep 2022 15:00:57 -0400 Subject: [PATCH] update --- _quarto.yml | 5 +- appendices/survey.qmd | 21 ++++++++ extras/custom-reference.docx | Bin 10253 -> 16516 bytes index.qmd | 78 ++++++++++++++++++++++++++++-- references.bib | 90 +++++++++++++++++++++++++++++++++++ 5 files changed, 187 insertions(+), 7 deletions(-) diff --git a/_quarto.yml b/_quarto.yml index 885bf52..8c19c4b 100644 --- a/_quarto.yml +++ b/_quarto.yml @@ -16,10 +16,11 @@ bibliography: references.bib csl: apa.csl format: - html: - theme: journal + #html: + #theme: journal docx: reference-doc: extras/custom-reference.docx + number-sections: false editor: visual diff --git a/appendices/survey.qmd b/appendices/survey.qmd index 10d2c5d..169a5cd 100644 --- a/appendices/survey.qmd +++ b/appendices/survey.qmd @@ -1,3 +1,5 @@ +# Draft Survey + ## Demographics What is your current role? @@ -6,6 +8,25 @@ Hospital Size? Annual Test Volume? +## Current Practices + +Does your lab auto verify tests? + +How was the criteria developed? + +Does your lab preform reflex testings? + +How was the criteria for reflex developed? + ## Features What is your current level of understanding of Machine Learning? + +Do you believe auto verification could be improved? + +How comfortable would you be with an algorithm verifying tests? + +What would be the biggest hurdles to implementing this system? 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use of Machine learning to develop algorithms to allow flexibility for automatic reflex testing in clinical chemistry. The goal is to fill the gap between hard coded reflex testing and fully manual reflective testing using machine learning algorithms. +This study will examine the use of Machine learning to develop +algorithms to allow flexibility for automatic reflex testing in clinical +chemistry. The goal is to fill the gap between hard coded reflex testing +and fully manual reflective testing using machine learning algorithms. @@ -12,8 +35,53 @@ This study will examine the use of Machine learning to develop algorithms to all ## Purpose and Research Question -### Draft Question - -What are the beliefs, attitudes, opinions, and knowledge about using machine learning in the clinical laboratory. +What are the beliefs, attitudes, opinions, and knowledge about using +machine learning in the clinical laboratory. ## Significance + +Health spending in the U.S. increased by 4.6% in 2019 to \$3.8 trillion +or \$11,582 per capita. This growth rate is in line with 2018 (4.7 +percent) and slightly faster than what was observed in 2017 (4.3 +percent) [@americanmedicalassociation2021]. Although laboratory costs +comprise only about 5% of the healthcare budget in the United States, it +is estimated that laboratory services drive up to 70% of all downstream +medical decisions, which encompass a substantial portion of the budget +[@ma2019]. As healthcare budgets increase, payers, including Medicare, +commercial insurers, and employers, will demand accountability and +eliminate the abuse and misuse of ineffective testing strategies +[@hernandez2003]. Increasingly, payers demand to know the value of the +tests, with value equaling quality per unit of cost. Payers want +laboratories to prove that tests are cost-effective; as reimbursement +rates decline for many standard laboratory tests, the incentives for +automated reflex testing rise for many clinical laboratories +[@hernandez2003]. Unnecessary laboratory tests are a significant source +of waste in the United States healthcare system. Prior studies suggest +that 20% of labs performed are unnecessary, wasting 200 billion dollars +each year [@li2022]. + +A typical example of reflex testing is thyrotropin (TSH), relaxing to +free thyroxine (Free T4 or FT4). TSH measurement is a sensitive +screening test for thyroid dysfunction. Guidelines from the American +Thyroid Association, the American Association of Clinical +Endocrinologists, and the National Academy of Clinical Biochemistry have +endorsed TSH measurement as the best first-line strategy for detecting +thyroid dysfunction in most clinical settings [@plebani2020]. +Traditionally the cutoff for reflex testing was simply the reference +range for a patient's sex and race. However, recent studies have +suggested that widening these ranges reduces reflex testing by up to 34% +[@plebani2020]. In an additional study, the authors concluded that the +TSH reference range leading to reflex Free T4 testing could likely be +widened to decrease the number of unnecessary Free T4 measurements +performed. This reduction would reduce overall costs to the medical +system without likely causing negative consequences of missing the +detection of people with thyroid hormone abnormalities +[@whitneyw.woodmansee2018]. + + + +The reduction in testing aside, the hard-coded rule still exists. +Additionally, machine learning may predict missing values in a patient's +record or even suggest further testing on a particular patient. In a +study at Massachusetts General hospital, researchers predicted ferritin +results based on already run laboratory testing [@charnaalbert2020]. diff --git a/references.bib b/references.bib index 421d81b..6e08295 100644 --- a/references.bib +++ b/references.bib @@ -45,3 +45,93 @@ note = {PMID: 33478239 PMCID: PMC7961679} } + +@misc{americanmedicalassociation2021, + title = {Trends in health care spending}, + author = {American Medical Association, }, + year = {2021}, + month = {05}, + date = {2021-05}, + url = {https://www.ama-assn.org/about/research/trends-health-care-spending}, + langid = {en} +} + +@article{ma2019, + title = {Estimated costs of 51 commonly ordered laboratory tests in Canada}, + author = {Ma, Irene and Lau, Cheryl K. and Ramdas, Zane and Jackson, Rhonda and Naugler, Christopher}, + year = {2019}, + month = {03}, + date = {2019-03-01}, + journal = {Clinical Biochemistry}, + pages = {58--60}, + volume = {65}, + doi = {10.1016/j.clinbiochem.2018.12.013}, + url = {https://www.sciencedirect.com/science/article/pii/S0009912018310543}, + langid = {en} +} + +@article{hernandez2003, + title = {Cost-Effectiveness of Laboratory Testing}, + author = {Hernandez, James S.}, + year = {2003}, + month = {04}, + date = {2003-04-01}, + journal = {Archives of Pathology & Laboratory Medicine}, + pages = {440--445}, + volume = {127}, + number = {4}, + doi = {10.5858/2003-127-0440-COLT}, + url = {https://doi.org/10.5858/2003-127-0440-COLT} +} + +@article{li2022, + title = {External Validation of a Laboratory Prediction Algorithm for the Reduction of Unnecessary Labs in the Critical Care Setting}, + author = {Li, Linda T. and Huang, Tongtong and Bernstam, Elmer V. and Jiang, Xiaoqian}, + year = {2022}, + month = {01}, + date = {2022-01-31}, + journal = {The American Journal of Medicine}, + doi = {10.1016/j.amjmed.2021.12.020}, + url = {https://www.sciencedirect.com/science/article/pii/S0002934322000481}, + langid = {en} +} + +@article{plebani2020, + title = {Reflex TSH strategy: the good, the bad and the ugly}, + author = {Plebani, Mario and Giovanella, Luca}, + year = {2020}, + month = {01}, + date = {2020-01-01}, + journal = {Clinical Chemistry and Laboratory Medicine (CCLM)}, + pages = {1--2}, + volume = {58}, + number = {1}, + doi = {10.1515/cclm-2019-0625}, + url = {https://www.degruyter.com/document/doi/10.1515/cclm-2019-0625/html?lang=en}, + note = {Publisher: De Gruyter}, + langid = {en} +} + +@article{whitneyw.woodmansee2018, + title = {Determination of optimal TSH ranges for reflex Free T4 testing}, + author = {Whitney W. Woodmansee, }, + year = {2018}, + month = {02}, + date = {2018-02}, + journal = {Clinical Thyroidology for the Public}, + pages = {3--4}, + volume = {11}, + number = {2}, + url = {https://www.thyroid.org/patient-thyroid-information/ct-for-patients/february-2018/vol-11-issue-2-p-3-4/}, + langid = {canadian} +} + +@misc{charnaalbert2020, + title = {Can machine learning algorithms predict lab values?}, + author = {Charna Albert, }, + year = {2020}, + month = {02}, + date = {2020-02-18}, + url = {https://www.captodayonline.com/can-machine-learning-algorithms-predict-lab-values/}, + langid = {canadian} +}