July 6, 2021
Chronic diseases, including stroke, diabetes, and cancer, are the leading cause of death and disability in the United States. Healthcare professionals at all levels, and the communities and patients they work with, are therefore invested in reducing the impact of these diseases.
Depending on the role a person takes in a healthcare system, whether they are a public health official, a healthcare organization leader, a healthcare provider, or a patient, they are going to have different concerns and questions about chronic disease and different strategies for addressing those concerns and questions. No matter the level at which people are facing the problem of chronic disease, laboratory testing provides data that is integral to choosing the best way forward.
Public health: How do we prevent chronic disease?
The National Health and Nutrition Examination Survey (NHANES) is an ongoing program to collect health data from a representative sample of Americans. The survey includes participant interviews and physical exams based on age and gender, including blood and urine tests for cholesterol, glucose, nutrition status, and kidney function. The data from this survey is used to determine the prevalence of chronic diseases and disease risk factors and to set standards for health measures such as blood pressure.
Using data collected in the NHANES program and other datasets, public health organizations focus their chronic disease prevention efforts on the most prevalent diseases and the major risk factors in their populations. For example, the National Center for Chronic Disease Prevention and Health Promotion targets the seven (7) most prominent chronic diseases for Americans:
- Heart disease
- Chronic lung disease
- Alzheimer’s disease
- Chronic kidney disease
The center also encourages people to reduce their risk of developing chronic diseases through healthy behaviors:
- Stop smoking
- Eat a healthy diet
- Exercise regularly
- Limit alcohol use
Promoting regular health screenings is an important strategy, because such screenings make people aware of medical conditions they have that can lead to the development of chronic disease. Some of these conditions, such as obesity or high blood pressure, are easily identified using a scale or blood pressure monitor. Other conditions, such as high cholesterol, require lab testing, a healthcare provider’s interpretation, and possibly multiple patient interactions with one or several healthcare organizations.
Healthcare organizations: How do we optimize chronic disease care?
Patients with chronic diseases account for 90% of annual healthcare costs in the United States, so healthcare leaders are always evaluating ways to reduce costs associated with caring for this patient population while maintaining the quality of care. As an important factor in managing chronic disease, lab testing is a critical element of this analysis.
Appropriate lab test utilization helps healthcare organizations improve clinical outcomes by reducing the risk of missed or delayed chronic disease diagnosis. Inappropriate use can lead to diagnostic errors and unnecessary healthcare costs. Standardizing test ordering, however, is not an easy task. It requires ongoing organizational, clinical, and technological resources and clear communication and buy-in among all the participants in the healthcare process.
Information needs to be shared across disciplines and departments for such an effort to be successful. Technology that compares lab test data from different systems and locations against accepted medical standards, such as hc1 PrecisionDx Advisor, can surface issues that cause lab testing related to chronic disease to be overused or underused across an organization. It can also monitor and measure the success of interventions to change ordering behavior, such as provider education, improvements to EMR test ordering interfaces, or requirements for additional approval for specialized testing. Of course, before the technology can do its job, the organization must do the hard work of gaining consensus on a course of action and implementing the agreed-upon interventions.
Providers: How do we best diagnose and treat patients with chronic diseases?
There are four main reasons clinical providers order lab tests related to chronic disease:
- Prevention: Test results for chronic disease risk factors can lead healthcare providers to recommend specific preventative measures to patients that will help them avoid or delay developing chronic disease. Chronic diseases can develop over a long time, sometimes without noticeable symptoms, which is why periodic screenings are recommended for patients with risk factors such as having a close family member with the disease or being middle-aged or older. When diseases such as cancer are caught in the early stages, they usually have a much better prognosis and a reduced cost of care.
- Diagnosis: For some chronic diseases, the results of a single blood test may be all that is needed for a diagnosis. A 6.5% or higher result on an Hemoglobin-A1C blood test means the patient has diabetes, for example. Other test results are not so cut-and-dried. They may just indicate that more tests, scans, or procedures are needed to establish a diagnosis.
- Treatment: Lab testing helps healthcare providers track side effects and evaluate whether a medication, lifestyle change, or other treatments are working as expected.
- Monitoring: Lab testing can check for recurrence or progression of a chronic disease.
Complicating matters is the fact that many U.S. adults, 40% to be specific, have more than one chronic disease to manage. It’s no wonder that providers want to make sure that they have as much data as possible, so they don’t miss anything.
But too much testing can lead to overdiagnosis and overtreatment and can cause patient harm. Consider this startling quote from the American Cancer Society Guidelines for the Early Detection of Cancer regarding PSA and other testing for prostate cancer, “Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment.”
Patients: How do we live with chronic disease?
High-value healthcare relies on clear communication between providers and patients, but studies have shown that both parties need to make fewer assumptions and ask more questions when it comes to testing.
The University of Michigan National Poll on Healthy Aging surveyed a sample of adults aged 50 to 80 and found:
- 25% thought their healthcare providers often recommended unnecessary tests, medications, or procedures. Half of the patients who were recommended a test they thought was unnecessary had the test anyway.
- 9% thought they needed a test, medication, or procedure that their provider said was unnecessary. Most patients received and understood the provider’s explanation for why it was unnecessary, but some patients didn’t receive any explanation or didn’t understand the explanation they were given.
In the BMJ Open Quality article, “Optimising laboratory monitoring of chronic conditions in primary care: a quality improvement framework,” researchers in the UK describe findings from interviews with patients who had their blood drawn for routine tests. “Patients wanted testing to tell them if they were ‘normal’, and if not, what needed to happen to return them to ‘normal’.” Yet, in many cases, testing results didn’t make a patient’s health situation any clearer. “Results generated by the laboratory were often presented in ways that obscured meaning and were prone to being misunderstood. In addition, results tended to reflect what is normal for a population. They rarely told us what is abnormal for the individual.”
The researchers advocate for a data-driven, systematic approach to appropriate test ordering, but emphasize that the success of such efforts relies on involving healthcare providers in the implementation of such an approach and making patients’ needs the driver for change. As the researchers state, the goal of lab testing should be to help patients and their caregivers make informed healthcare decisions.
Patients with chronic disease want answers they can act on. Tests that are unlikely to lead to any change in outcome cause harm by draining time, money, and energy from people who already have the daily stress of dealing with chronic illness.
To learn more about how hc1 is securely and intelligently integrating, normalizing, enriching, and transforming health data into the signals that identify risk and drive care decisions catering to each patient’s unique needs, click here to download our latest white paper.