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A multimodal intervention for reducing unnecessary repeat HbA1c testing

  • Jason Baek
    Affiliations
    Temerty Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Toronto, ON Canada M5S 1A8
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  • Vamana Rajeswaran
    Affiliations
    Temerty Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Toronto, ON Canada M5S 1A8

    Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON Canada, M4N 3M5
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  • Susan Tran
    Affiliations
    Temerty Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Toronto, ON Canada M5S 1A8

    Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON Canada, M4N 3M5
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  • Lisa Alexander
    Affiliations
    Temerty Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Toronto, ON Canada M5S 1A8

    Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON Canada, M4N 3M5
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  • Diana Jaskolka
    Affiliations
    Temerty Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Toronto, ON Canada M5S 1A8

    Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON Canada, M4N 3M5
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  • Shirine Usmani
    Affiliations
    Temerty Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Toronto, ON Canada M5S 1A8

    Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON Canada, M4N 3M5
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  • Paul Yip
    Affiliations
    Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON Canada, M4N 3M5
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  • Geetha Mukerji
    Correspondence
    Corresponding Author: Dr. Geetha Mukerji, Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, Ontario M5S 1B3
    Affiliations
    Temerty Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Toronto, ON Canada M5S 1A8

    Women’s College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto ON Canada M5S 1B3
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      ABSTRACT

      Objective

      Reducing unnecessary tests that do not enhance quality can promote healthcare value. Glycated hemoglobin (A1c) is often ordered at a frequency exceeding the recommendation of once every three months. We conducted a Quality Improvement (QI) initiative to reduce unnecessary repeat testing at a tertiary care academic hospital by 75%.

      Methods

      A retrospective baseline analysis was conducted on laboratory data from 2019 which enumerated unnecessary A1c tests, defined as repeat tests ordered within 60 days. A multi-faceted change intervention with iterative Plan-Do-Study-Act cycles was introduced in March 2019 to educate providers and to automatically cancel A1c test requested within 60 days. Monthly totals of A1c test processed were plotted on SPC charts.

      Results

      In 2019, 11% of all A1c tests ordered were unnecessary. Between March 2020 and January 2021, 11% of tests (total of 14,247 tests) were unnecessary, of which 84% were cancelled with our intervention. Providers in cardiology and nephrology accounted for over half (55%) of unnecessary tests ordered.

      Conclusion

      A two-pronged approach informed by root cause analysis, and comprised of gatekeeping and provider education, can effectively promote resource stewardship for reducing unnecessary A1c testing.

      Keywords

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