Background/Purpose:

More than 94,000 ANA tests are performed each year resulting in an estimated cost of 2.24 million dollars annually. The American College of Rheumatology Choosing Wisely Campaign emphasizes the appropriate use of autoantibody testing focusing on high value and cost conscious care. Besides rheumatologic diseases, positive ANA results can be seen in several non-rheumatic pathologies and in normal healthy individuals. Improper use of immunologic testing can result in misdiagnosis, patient concerns, inappropriate therapy and wasted health care resources. We sought to review physician practicing habits of utilizing the ANA screen prior to ordering ANA panel, unless otherwise warranted in specific clinical settings.

 Methods:

We conducted a retrospective chart review of patients aged 18 years or older admitted to our teaching hospital from Jan 1^st, 2012 to December 31^st, 2014 who had an ANA screen and/or an ANA panel ordered. Fifty percent of these charts were selected using a random number generator and a total of 625 charts were reviewed. Data was collected on the ANA test that was ordered, date of the test performed, result of the tests, history of prior SLE, history of other autoimmune diseases, and prior positive ANA testing.

Results:

Of the 625 patient charts that were reviewed, five patients (0.8%) had a preexisting diagnosis of SLE and 20 patients (3.2%) had previously been diagnosed with non-SLE autoimmune disorders. 208 (33%) patients had an ANA screen ordered, and 417 (67%) had only an ANA panel. Of those patients who had an ANA screen ordered (208), 73% appropriately had the ANA screen ordered first, and 27% had an ANA screen ordered at the same time or after the ANA panel. In those patients who had an ANA screen ordered, 91% of those screens were negative and 9% were positive. Interestingly, in those patients where only an ANA panel was ordered without any prior ANA screening, only 0.05% (2/417) was actually positive.

Conclusion:

Sixty six percent (417) of patients had an ANA panel ordered without an ANA screen, of which 99.5% were negative, leading to an estimated excess cost of 342,254 dollars over 3 years in this test alone. Our Electronic Medical Recording system has different ANA testing options which currently includes the option to only order an ANA panel without the ANA screen. An expanded ANA panel without specific clinical suspicion may result in falsely positive results leading to unnecessary workup. Our next step in implementing change is to remove the option of ‘ANA panel only’ in our Electronic Medical Recording system, and to replace it with ‘ANA screen with reflex to ANA pattern, titer and panel’ to avoid unnecessary testing.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/investigating-opportunities-for-cost-conscious-care-a-review-of-physician-practice-in-ordering-anti-nuclear-antibody-testing-at-an-academic-community-hospital/