A ‘Trigger’ Can Make Sure Abnormal TSH Levels Are Followed Up

by U.S. Medicine

October 28, 2018

HOUSTON — In busy outpatient clinics, following up on abnormal test results too often falls by the wayside, according to a new study.

An article in the Journal of General Internal Medicine raised the question of whether surveillance systems that use trigger tools to identify delayed follow-up could help remedy the problem.1

A study team from the Houston VA Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VAMC and the Baylor College of Medicine designed a study to find out.

Their objective was to develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism.

To do that, researchers developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up — defined as greater than 60 days — after an abnormal TSH.

The algorithm was then retrospectively applied to a large EHR data warehouse within the VA. Specifically, the study team focused on patient records from two large VA networks for the period from Jan. 1, 2011, to Dec. 31, 2011, reviewing and identifying records d to confirm delays in follow-up.

The article noted that, during the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1,250 patients on treatment for hypothyroidism with elevated TSH.

Results indicated that, of those patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%).

“An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up,” study authors concluded. “Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.”

1. Meyer AND, Murphy DR, Al-Mutairi A, Sittig DF, Wei L, Russo E, Singh H. Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism. J Gen Intern Med. 2017 Jul;32(7):753-759. doi: 10.1007/s11606-017-3988-z. Epub 2017 Jan 30. PubMed PMID: 28138875; PubMed Central PMCID: PMC5481223.

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