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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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Article Info
Publication History
Accepted:
June 15,
2022
Received in revised form:
May 7,
2022
Received:
September 13,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Key Message:
Current clinical practice guidelines caution against the testing of repeating HbA1c measurement earlier than 12 weeks as it has limited utility and negative implications on patient and system health. Previous studies both in Canada and abroad have demonstrated the application of a laboratory forced function as an effective intervention to reduce unnecessary repeat HbA1c testing. This study demonstrates the effectiveness of a multi-faceted intervention informed by root-cause analysis as a viable method for reducing unnecessary repeat HbA1c testing in a tertiary care academic centre.
Identification
Copyright
© 2022 Canadian Diabetes Association.
