Abstract
Objectives
Reducing unnecessary tests that do not enhance quality can promote health-care value.
Glycated hemoglobin (A1C) is often ordered at a frequency exceeding the recommendation
of once every 3 months. We conducted a quality improvement (QI) initiative aimed to
reduce unnecessary repeat testing by 75% at a tertiary care academic hospital.
Methods
A retrospective baseline analysis was conducted on laboratory data from 2019 that
enumerated unnecessary A1C tests, defined as repeat tests ordered within 60 days.
A multifaceted change intervention with iterative plan–do–study–act cycles was introduced
in March 2019 to educate providers and to automatically cancel A1C tests requested
within 60 days. Monthly totals of A1C testing processed were plotted on statistical
process control charts.
Results
In 2019, 11% of all A1C tests ordered were unnecessary. Between March 2020 and January
2021, 11% of the tests (N=14,247 tests) were unnecessary, of which 84% were cancelled
with our intervention. Providers in cardiology and nephrology accounted for over half
(55%) of the unnecessary tests ordered.
Conclusions
A 2-pronged approach informed by root-cause analysis, and comprised of gatekeeping
and provider education, can effectively promote resource stewardship for reducing
unnecessary A1C testing.
Résumé
Objectifs
La diminution des analyses superflues qui ne permettent pas d’améliorer la qualité
peut contribuer à promouvoir la valeur des soins de santé. La fréquence des ordonnances
d’analyses de l’hémoglobine glyquée (A1c) excède souvent la recommandation de 1 analyse
tous les 3 mois. Nous avons mené un projet d’amélioration de la qualité (AQ) qui visait
à réduire de 75 % les analyses superflues d’un hôpital universitaire de soins tertiaires.
Méthodes
À compter de 2019, nous avons mené une première analyse rétrospective des données
de laboratoire qui énumérait les analyses superflues de l’A1c, à savoir les analyses
répétées prescrites dans les 60 jours. En mars 2019, nous avons offert une intervention
à multiples facettes pour tester les changements au moyen des cycles plan–do–study–act (PDSA) répétés afin d’informer les prestataires et d’annuler automatiquement les
analyses d’A1c demandées dans les 60 jours. Nous avons représenté les totaux mensuels
des analyses de l’A1c traitées sur des graphiques de maîtrise statistique des procédés.
Résultats
En 2019, 11 % de toutes les analyses de l’A1c prescrites étaient superflues. Entre
mars 2020 et janvier 2021, parmi les 11 % d’analyses (n = 14 247 analyses) qui étaient
superflues, 84 % ont été annulées grâce à notre intervention. Les prestataires en
cardiologie et en néphrologie réalisaient plus de la moitié (55 %) des ordonnances
d’analyses superflues.
Conclusions
Une approche à 2 volets fondée sur une analyse des causes fondamentales et constituée
de contrôle de l’accès et d’enseignement aux prestataires peut promouvoir efficacement
la gestion des ressources afin de réduire les analyses superflues de l’A1c.
Keywords
Mots clés
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Article info
Publication history
Published online: June 30, 2022
Accepted:
June 15,
2022
Received in revised form:
May 7,
2022
Received:
September 13,
2021
Identification
Copyright
© 2022 Canadian Diabetes Association.
