{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:15:16Z","timestamp":1753877716794,"version":"3.41.2"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T00:00:00Z","timestamp":1553817600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Inpatient HIV care often requires specialized laboratory testing with which practitioners may not be familiar. In addition, computerized physician order entry allows for ordering tests without understanding test indications, but it can also provide a venue for education and diagnostic stewardship.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All charts of HIV-positive patients hospitalized at a tertiary care public safety net hospital in Houston, Texas, between January 1, 2014, and June 30, 2014, were reviewed for a set list of laboratory tests. Appropriateness of test ordering was assessed by 2 providers. Cost estimates for each test were obtained from Medicaid and a national nonprofit health care charge database.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 274 HIV-positive patients were admitted 429 times in the 6-month study period. During the study period, 45% of the study laboratory tests ordered were not indicated. A total of 532 hepatitis serologies were ordered, only 52% of which were indicated. Overall, 71 serum qualitative cytomegalovirus (CMV) polymerase chain reactions (PCRs) and eight CMV quantitative PCRs were ordered, with most (85%) qualitative PCRs ordered for nonspecific signs of infection (eg, fever). Other tests ordered without clear indications included Aspergillus IgE (7), serum Epstein-Barr virus (EBV) PCR (5), parvovirus serology (7), and Toxoplasma IgM (18). Overall, the estimated laboratory cost of inappropriate testing over the study period was between $14 000 and $92 000, depending on which cost database was used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Many tests ordered in HIV-positive inpatients do not have indications, representing a substantial source of health care waste and cost and potentially leading to inappropriate treatment. Opportunities exist to decrease waste through education of trainees and hospitalists and through implementation of diagnostic stewardship via the electronic medical record.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofz158","type":"journal-article","created":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T03:19:35Z","timestamp":1553829575000},"source":"Crossref","is-referenced-by-count":6,"title":["Ordering Patterns and Costs of Specialized Laboratory Testing by Hospitalists and House Staff in Hospitalized Patients With HIV at a County Hospital: An Opportunity for Diagnostic Stewardship"],"prefix":"10.1093","volume":"6","author":[{"given":"Kathryn","family":"Bolles","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Washington, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laila","family":"Woc-Colburn","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J","family":"Hamill","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas"},{"name":"Medical Care Line, Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vagish","family":"Hemmige","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,3,29]]},"reference":[{"key":"2020081003481193200_CIT0001","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1186\/1471-2334-14-536","article-title":"National trends in hospitalization and mortality rates for patients with HIV, HCV, or HIV\/HCV coinfection from 1996\u20132010 in the United States: a cross-sectional study","volume":"14","author":"Oramasionwu","year":"2014","journal-title":"BMC Infect Dis"},{"key":"2020081003481193200_CIT0002","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1089\/108729103322555953","article-title":"Hospitalized HIV-infected patients in the HAART era: a view from the inner city","volume":"17","author":"Pulvirenti","year":"2003","journal-title":"AIDS Patient Care STDS"},{"key":"2020081003481193200_CIT0003","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1086\/529200","article-title":"Do hospitalists or physicians with greater inpatient HIV experience improve HIV care in the era of highly active antiretroviral therapy? 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