CONTROLLED UTILIZATION OF INDUCED SPUTUM ANALYSIS IN THE DIAGNOSIS OFPNEUMOCYSTIS-CARINII PNEUMONIA

We investigated the outcome and potential cost savings of a system des igned to limit physician access to induced sputum analysis (ISA) for t he diagnosis Of Pneumocystis carinii pneumonia (PCP). Four respiratory medicine physicians screened all requests for ISA to determine the pr etest likelihood of PCP. Twenty-two of 102 requests for ISA over a 1-y ear period were denied due to a low clinical suspicion for PCP. Seven individuals had a definitive alternative diagnosis confirmed and the r emaining 15 were empirically treated for a presumptive diagnosis. All individuals were followed for at least 60 days or until death. None of the 22 individuals developed PCP during the follow-up period. We esti mate that this approach saved $27,474, avoided exposure of health care workers to Mycobacterium tuberculosis, and was educational for the re ferring physicians.