{"id":"https://openalex.org/W4414740776","doi":"https://doi.org/10.1093/clinchem/hvaf086.556","title":"B-162 Optimizing Thyroid Function Testing: Reducing Unnecessary Orders and Enhancing Patient Care Through Evidence-Based Cascade Algorithms","display_name":"B-162 Optimizing Thyroid Function Testing: Reducing Unnecessary Orders and Enhancing Patient Care Through Evidence-Based Cascade Algorithms","publication_year":2025,"publication_date":"2025-10-01","ids":{"openalex":"https://openalex.org/W4414740776","doi":"https://doi.org/10.1093/clinchem/hvaf086.556"},"language":"en","primary_location":{"id":"doi:10.1093/clinchem/hvaf086.556","doi":"https://doi.org/10.1093/clinchem/hvaf086.556","is_oa":true,"landing_page_url":"https://doi.org/10.1093/clinchem/hvaf086.556","pdf_url":"https://academic.oup.com/clinchem/article-pdf/71/Supplement_1/hvaf086.556/64461723/hvaf086.556.pdf","source":{"id":"https://openalex.org/S139212996","display_name":"Clinical Chemistry","issn_l":"0009-9147","issn":["0009-9147","1530-8561"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320272","host_organization_name":"American Association for Clinical Chemistry","host_organization_lineage":["https://openalex.org/P4310320272"],"host_organization_lineage_names":["American Association for Clinical Chemistry"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Chemistry","raw_type":"journal-article"},"volume":null,"type":"conference-abstract","is_traditional":false,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"bronze","oa_url":"https://academic.oup.com/clinchem/article-pdf/71/Supplement_1/hvaf086.556/64461723/hvaf086.556.pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5119810081","display_name":"Kim Terrio","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1330342723","display_name":"Mayo Clinic","ror":"https://ror.org/02qp3tb03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1330342723"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Kim Terrio","raw_affiliation_strings":["Mayo Clinic , Rochester, Minnesota"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Mayo Clinic , Rochester, Minnesota","institution_ids":["https://openalex.org/I1330342723"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5088888673","display_name":"Bryan J. Dangott","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1330342723","display_name":"Mayo Clinic","ror":"https://ror.org/02qp3tb03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1330342723"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Bryan Dangott","raw_affiliation_strings":["Mayo Clinic , Rochester, Minnesota"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Mayo Clinic , Rochester, Minnesota","institution_ids":["https://openalex.org/I1330342723"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5070087999","display_name":"Brad S. Karon","orcid":"https://orcid.org/0000-0002-2562-4835","observed_orcids":["https://orcid.org/0000-0002-2562-4835"]},"institutions":[{"id":"https://openalex.org/I1330342723","display_name":"Mayo Clinic","ror":"https://ror.org/02qp3tb03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1330342723"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Brad Karon","raw_affiliation_strings":["Mayo Clinic , Rochester, Minnesota"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Mayo Clinic , Rochester, Minnesota","institution_ids":["https://openalex.org/I1330342723"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5015018740","display_name":"Chady Meroueh","orcid":"https://orcid.org/0000-0003-2352-4336","observed_orcids":["https://orcid.org/0000-0003-2352-4336"]},"institutions":[{"id":"https://openalex.org/I1330342723","display_name":"Mayo Clinic","ror":"https://ror.org/02qp3tb03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1330342723"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Chady Meroueh","raw_affiliation_strings":["Mayo Clinic , Rochester, Minnesota"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Mayo Clinic , Rochester, Minnesota","institution_ids":["https://openalex.org/I1330342723"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014196063","display_name":"William Mundell","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1330342723","display_name":"Mayo Clinic","ror":"https://ror.org/02qp3tb03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1330342723"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"William Mundell","raw_affiliation_strings":["Mayo Clinic , Rochester, Minnesota"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Mayo Clinic , Rochester, Minnesota","institution_ids":["https://openalex.org/I1330342723"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5085920293","display_name":"Sara G. Sandleback","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1330342723","display_name":"Mayo Clinic","ror":"https://ror.org/02qp3tb03","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1330342723"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sara Sandleback","raw_affiliation_strings":["Mayo Clinic , Rochester, Minnesota"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Mayo Clinic , Rochester, Minnesota","institution_ids":["https://openalex.org/I1330342723"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I1330342723"],"apc_list":{"value":4636,"currency":"USD","value_usd":4636},"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":"71","issue":"Supplement_1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T13555","display_name":"Healthcare cost, quality, practices","score":0.8730000257492065,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T13555","display_name":"Healthcare cost, quality, practices","score":0.8730000257492065,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11314","display_name":"Clinical Laboratory Practices and Quality Control","score":0.10719999670982361,"subfield":{"id":"https://openalex.org/subfields/3607","display_name":"Medical Laboratory Technology"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10293","display_name":"Thyroid Disorders and Treatments","score":0.013799999840557575,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/thyroid-function-tests","display_name":"thyroid function tests","score":0.9350000023841858},{"id":"https://openalex.org/keywords/thyroid-stimulating-hormone","display_name":"thyroid-stimulating hormone","score":0.847000002861023},{"id":"https://openalex.org/keywords/free-thyroxine","display_name":"free thyroxine","score":0.8529999852180481},{"id":"https://openalex.org/keywords/total-t3","display_name":"total T3","score":0.9879999756813049},{"id":"https://openalex.org/keywords/unnecessary-laboratory-tests","display_name":"unnecessary laboratory testing","score":0.671999990940094},{"id":"https://openalex.org/keywords/concurrent-testing","display_name":"concurrent testing","score":0.5339999794960022},{"id":"https://openalex.org/keywords/laboratory-stewardship","display_name":"laboratory stewardship","score":0.6980000138282776},{"id":"https://openalex.org/keywords/cost-reduction","display_name":"cost reduction","score":0.8690000176429749},{"id":"https://openalex.org/keywords/quality-indicators","display_name":"quality indicators","score":0.5450000166893005},{"id":"https://openalex.org/keywords/unnecessary-testing","display_name":"unnecessary testing","score":0.4180000126361847},{"id":"https://openalex.org/keywords/misdiagnosis-risk","display_name":"misdiagnosis risk","score":0.7229999899864197}],"concepts":[{"id":"https://openalex.org/C34146451","wikidata":"https://www.wikidata.org/wiki/Q5048094","display_name":"Cascade","level":2,"score":0.6420000195503235},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6312999725341797},{"id":"https://openalex.org/C2993291352","wikidata":"https://www.wikidata.org/wiki/Q16399","display_name":"Thyroid function","level":3,"score":0.5748000144958496},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.5234000086784363},{"id":"https://openalex.org/C11413529","wikidata":"https://www.wikidata.org/wiki/Q8366","display_name":"Algorithm","level":1,"score":0.49959999322891235},{"id":"https://openalex.org/C2777267654","wikidata":"https://www.wikidata.org/wiki/Q3519023","display_name":"Test (biology)","level":2,"score":0.49470001459121704},{"id":"https://openalex.org/C2989236134","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Patient care","level":2,"score":0.4772999882698059},{"id":"https://openalex.org/C2778840127","wikidata":"https://www.wikidata.org/wiki/Q712838","display_name":"Thyroid function tests","level":3,"score":0.42329999804496765},{"id":"https://openalex.org/C14036430","wikidata":"https://www.wikidata.org/wiki/Q3736076","display_name":"Function (biology)","level":2,"score":0.4081000089645386},{"id":"https://openalex.org/C2780665704","wikidata":"https://www.wikidata.org/wiki/Q959298","display_name":"Intervention (counseling)","level":2,"score":0.3246000111103058},{"id":"https://openalex.org/C2779328685","wikidata":"https://www.wikidata.org/wiki/Q1475557","display_name":"Patient safety","level":3,"score":0.31299999356269836},{"id":"https://openalex.org/C526584372","wikidata":"https://www.wikidata.org/wiki/Q16399","display_name":"Thyroid","level":2,"score":0.3091000020503998},{"id":"https://openalex.org/C182306322","wikidata":"https://www.wikidata.org/wiki/Q1779371","display_name":"Order (exchange)","level":2,"score":0.29429998993873596},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.2752000093460083},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.2709999978542328},{"id":"https://openalex.org/C16910744","wikidata":"https://www.wikidata.org/wiki/Q7705759","display_name":"Test data","level":2,"score":0.2662999927997589},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.2630000114440918},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.2630000114440918},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.2599000036716461}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1093/clinchem/hvaf086.556","doi":"https://doi.org/10.1093/clinchem/hvaf086.556","is_oa":true,"landing_page_url":"https://doi.org/10.1093/clinchem/hvaf086.556","pdf_url":"https://academic.oup.com/clinchem/article-pdf/71/Supplement_1/hvaf086.556/64461723/hvaf086.556.pdf","source":{"id":"https://openalex.org/S139212996","display_name":"Clinical Chemistry","issn_l":"0009-9147","issn":["0009-9147","1530-8561"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320272","host_organization_name":"American Association for Clinical Chemistry","host_organization_lineage":["https://openalex.org/P4310320272"],"host_organization_lineage_names":["American Association for Clinical Chemistry"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Chemistry","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1093/clinchem/hvaf086.556","doi":"https://doi.org/10.1093/clinchem/hvaf086.556","is_oa":true,"landing_page_url":"https://doi.org/10.1093/clinchem/hvaf086.556","pdf_url":"https://academic.oup.com/clinchem/article-pdf/71/Supplement_1/hvaf086.556/64461723/hvaf086.556.pdf","source":{"id":"https://openalex.org/S139212996","display_name":"Clinical Chemistry","issn_l":"0009-9147","issn":["0009-9147","1530-8561"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320272","host_organization_name":"American Association for Clinical Chemistry","host_organization_lineage":["https://openalex.org/P4310320272"],"host_organization_lineage_names":["American Association for Clinical Chemistry"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Clinical Chemistry","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.98580002784729}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W4414740776.pdf","grobid_xml":"https://content.openalex.org/works/W4414740776.grobid-xml"},"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4408635381","https://openalex.org/W3025834031","https://openalex.org/W2609746975","https://openalex.org/W2794649711","https://openalex.org/W180029534","https://openalex.org/W2766420284","https://openalex.org/W4294168565","https://openalex.org/W4410732602","https://openalex.org/W2944930342","https://openalex.org/W7096477076"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Thyroid":[2,377],"function":[3,20,85,144,296,399],"testing":[4,22,56,73,86,90,145,165,378,400],"is":[5,28,57,63,194],"a":[6,46,118,175,195,235,337,403],"common":[7],"laboratory":[8,327,405,432,480],"service":[9],"that":[10,117,198,286,408,459],"can":[11,82],"be":[12,76],"optimized":[13],"by":[14,203,383,463],"implementing":[15],"evidence-based":[16,427],"algorithms.":[17],"The":[18,38,171,333,397,418,434],"thyroid":[19,36,84,143,158,295,398],"cascade":[21,39,89,153,185,474],"approach":[23,91,133,475],"at":[24,79],"Mayo":[25,231],"Clinic":[26,232],"Labs":[27],"utilized":[29],"to":[30,141,147,150,166,182,201,293,430,442,446,476,493],"effectively":[31],"evaluate":[32],"and":[33,163,221,226,245,253,256,275,319,322,326,345,359,373,390,415,423,454,489],"monitor":[34],"functional":[35],"status.":[37],"begins":[40],"with":[41,87,107,385,491],"thyroid-stimulating":[42],"hormone":[43],"(TSH)":[44],"as":[45,93,264,277,284],"screening":[47],"marker.":[48],"When":[49,59],"TSH":[50,61,104,278],"levels":[51],"are":[52,370,460],"normal,":[53],"no":[54],"additional":[55],"necessary.":[58],"the":[60,131,142,152,184,188,211,214,240,258,268,272,289,294,305,311,330,392,421,443,464,473,483,487,495,498],"result":[62],"abnormal,":[64],"appropriate":[65],"follow-up":[66],"free":[67,108,355],"T4,":[68,109,250,356],"total":[69,110,357],"T3,":[70,111,252,358],"and/or":[71,112],"TPO":[72,254],"will":[74],"automatically":[75],"performed.":[77],"Providers":[78],"our":[80],"institution":[81],"order":[83,151,178,183],"this":[88],"or":[92],"standalone":[94],"individual":[95,157,189,205],"orderable":[96,190],"tests.":[97,191,279,361],"Initial":[98],"data":[99,228],"analysis":[100,115],"showed":[101],"patterns":[102],"of":[103,121,213,243,248,354,394,425,479,486,497],"ordered":[105,123],"concurrently":[106,122],"anti-TPO.":[113],"Further":[114],"revealed":[116],"high":[119],"number":[120],"tests":[124,206,265,285,440],"would":[125],"not":[126,461],"have":[127],"been":[128,134],"necessary":[129],"had":[130],"algorithmic":[132],"followed.":[135],"This":[136,192],"opportunity":[137],"for":[138,310,456],"improvement":[139],"led":[140],"initiative":[146,172,215,401,419],"direct":[148],"providers":[149,181,200,325,492],"test":[154,217,313,452],"rather":[155,186],"than":[156,187],"tests,":[159],"thereby":[160],"reducing":[161,388],"concurrent":[162,244,343],"unnecessary":[164,246,352],"improve":[167],"patient":[168,270,413,457],"care.":[169],"Methods":[170],"involved":[173],"creating":[174],"new":[176],"Epic":[177],"panel":[179],"directing":[180],"intervention":[193,334],"soft":[196],"stop":[197],"allows":[199],"proceed":[202],"ordering":[204,297],"if":[207],"desired.":[208],"We":[209,238,316],"evaluated":[210],"impact":[212],"on":[216,271,304,365],"utilization,":[218],"cost":[219],"savings,":[220],"quality":[222,379],"indicators":[223],"using":[224,426],"pre-":[225],"post-intervention":[227],"from":[229,267,324],"all":[230,439],"sites":[233],"over":[234],"9-month":[236],"period.":[237],"compared":[239],"monthly":[241,340,349,372],"volumes":[242],"orders":[247,261,281,344,353],"Free":[249],"Total":[251],"before":[255],"after":[257],"intervention.":[259],"Concurrent":[260],"were":[262,282,287,301],"defined":[263,283],"collected":[266],"same":[269,273],"date":[274],"time":[276],"Unnecessary":[280],"outside":[288],"reflex":[290,428],"range":[291],"according":[292],"algorithm.":[298],"Cost":[299],"savings":[300,363],"calculated":[302],"based":[303,364],"2024":[306,366],"CMS":[307,367],"reimbursement":[308,368],"rates":[309,369],"associated":[312],"CPT\u00ae":[314],"codes.":[315],"also":[317,381],"monitored":[318],"addressed":[320],"feedback":[321],"requests":[323],"staff":[328],"throughout":[329],"initiative.":[331,499],"Results":[332],"resulted":[335],"in":[336,342,351,451],"20%":[338],"average":[339,348],"reduction":[341,350],"an":[346],"18%":[347],"anti-TPO":[360],"Estimated":[362],"$5,000":[371],"nearly":[374],"$60,000":[375],"annually.":[376],"was":[380,402],"improved":[382,412],"aligning":[384],"clinical":[386],"guidelines,":[387],"over-testing,":[389],"minimizing":[391],"risk":[393],"misdiagnosis.":[395],"Conclusion":[396],"successful":[404],"stewardship":[406],"project":[407],"reduced":[409,416],"redundant":[410],"testing,":[411],"care,":[414],"costs.":[417],"demonstrated":[420],"feasibility":[422],"effectiveness":[424],"algorithms":[429],"optimize":[431],"testing.":[433],"lessons":[435],"learned":[436],"include":[437,471],"assessing":[438],"related":[441],"disease":[444],"condition":[445],"mitigate":[447],"potential":[448],"unintended":[449],"increases":[450],"usage":[453],"accounting":[455],"groups":[458],"covered":[462],"intended":[465],"algorithm*s":[466],"target":[467],"population.":[468],"Future":[469],"directions":[470],"expanding":[472],"other":[477],"areas":[478],"medicine,":[481],"evaluating":[482],"long-term":[484],"outcomes":[485],"initiative,":[488],"engaging":[490],"ensure":[494],"adoption":[496]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2025-10-10T00:00:00"}