Evaluation of a provincial intervention to reduce redundant hemoglobin A1c testing
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Irene Ma1, Maggie Guo2, Jeannine Viczko2
1Departments of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Canada.
Insights
Alberta’s provincial initiative to reduce unnecessary HbA1c testing led to a 3.3% decrease in test orders. This intervention resulted in significant cost savings, demonstrating the effectiveness of guideline-aligned diabetes management.
Area of Science:
- Clinical Chemistry
- Health Services Research
- Diabetes Mellitus Management
Background:
- Canadian Diabetes Association guidelines recommend HbA1c testing every 3 months for individuals with diabetes mellitus.
- Alberta implemented a provincial intervention to limit HbA1c test orders to one per 90 days, reducing inappropriate testing.
- This study evaluates the impact of Alberta's intervention on redundant HbA1c testing.
Purpose of the Study:
- To assess the effectiveness of a provincial intervention aimed at reducing inappropriate HbA1c testing in Alberta.
- To quantify the reduction in HbA1c test orders following the intervention.
- To determine the economic impact of reduced HbA1c testing.
Main Methods:
- Collected monthly HbA1c test order counts from Edmonton and Calgary, Alberta (January 2013 - December 2016).
- Utilized Winters' Additive time series model to predict post-intervention HbA1c test volumes.
- Compared predicted volumes with observed volumes to estimate intervention effect and calculate cost savings.
Main Results:
- A 3.3% reduction in observed HbA1c tests compared to predicted volumes in the first 14 months post-intervention.
- Estimated cost savings of $145,422 within the initial 14 months, based on a $3.50 reagent cost per test.
- Demonstrated a measurable decrease in HbA1c test orders in urban Alberta following the initiative.
Conclusions:
- The provincial initiative achieved a modest reduction in HbA1c test orders in urban Alberta.
- The intervention aligns with recommended guidelines for diabetes mellitus management.
- The findings suggest potential for cost savings through optimized laboratory testing protocols.
Background:
The Canadian Diabetes Association recommends testing most individuals with diabetes mellitus using HbA1c once every 3months. In Alberta, Canada, a provincial intervention to reduce inappropriate HbA1c test orders was implemented to align with this guideline, where only one HbA1c test request every 90days for most individuals can be processed. Here, we evaluated the provincial intervention to reduce redundant HbA1c testing in Alberta.
Methods:
Total counts of all HbA1c tests ordered within Edmonton and Calgary, Alberta, were collected from the respective Laboratory Information Systems each month between January 2013 and December 2016. Winters' Additive time series model was built to predict the HbA1c test volume after intervention (November 1, 2015 onwards) and compared with the observed test volume to estimate the effect of the intervention. The estimated change in test volume was then multiplied by the estimated cost to determine the economic impact.
Results:
During the first 14months of the intervention for Alberta, there was a 3.3% reduction in the number of observed HbA1c tests compared to the predicted volume. With an estimated marginal reagent cost of $3.50 per unit, this resulted in a cost savings of $145,422 in the first 14months of the provincial intervention.
Conclusion:
A modest reduction in HbA1c test orders was observed in the urban areas of Alberta since the implementation of this provincial initiative.
