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Optimising laboratory monitoring of chronic conditions in primary care: a quality improvement framework
Darunee Whiting1, Richard Croker1,2, Jessica Watson3
1NHS Northern, Eastern and Western Devon Clinical Commissioning Group, South Molton, UK.
Insights
Standardizing chronic condition blood tests in UK primary care reduced testing by 14-22% without missing pathology. This quality improvement initiative saved an estimated £200,000 in costs and reduced patient anxiety.
Area of Science:
- Primary Care Medicine
- Clinical Pathology
- Health Services Research
Background:
- Significant variation exists in blood testing for chronic conditions in UK primary care.
- Not all routine blood tests are evidence-based or guideline-adherent, leading to unwarranted testing.
- Unwarranted testing incurs costs, increases workload, and can cause patient anxiety.
Purpose of the Study:
- To standardize blood tests for chronic condition monitoring in primary care.
- To measure and reduce the harms associated with unwarranted blood testing.
- To improve quality of care and reduce system costs through optimized testing protocols.
Main Methods:
- Developed standardized chronic disease test groups aligned with current guidelines.
- Implemented standardized testing via one-click electronic ordering systems.
- Measured baseline harms and conducted quality improvement cycles with clinician engagement.
Main Results:
- Primary care testing rates decreased by 14% for full blood count and 22% for liver function tests.
- No reduction in the detection of significant pathology was observed.
- Estimated cost savings of £200,000 and similar reductions in downstream referral costs.
Conclusions:
- Standardized chronic disease test groups integrated into electronic ordering systems improve quality.
- Clinician engagement is crucial for successful implementation and cost reduction.
- Optimizing blood test monitoring in primary care benefits both patient care and healthcare economics.
Abstract:
Monitoring of chronic conditions accounts for a significant proportion of blood testing in UK primary care; not all of this is based on evidence or guidelines. National benchmarking shows significant variation in testing rates for common blood tests. This project set out to standardise the blood tests used for monitoring of chronic conditions in primary care across North Devon, and to measure and reduce the harms of unwarranted testing. Chronic disease test groups were developed in line with current guidelines and implemented using one-click electronic test ordering systems. The main difference from previous general practitioner practice algorithms was removing the requirement for full blood count and liver function test monitoring for many conditions. Baseline harms of testing were measured and included significant costs, workload and patient anxiety. By defining the scale of the problem, we were able to leverage change across several cycles of quality improvement, using a pathology optimisation forum for peer-led improvement, and developing a framework focusing on what matters to patients. Overall primary care testing rates in North Devon fell by 14% for full blood count testing and 22% for liver function tests, but without a reduction in the number of tests showing possible significant pathology. We estimate that this has reduced testing costs by £200 000 across a population of around 180 000 people and has reduced downstream referral costs by a similar amount. Introduction of simple chronic disease test groups into primary care electronic ordering systems, when used alongside engagement with clinicians, leads to both quality improvement and reduction in system costs.
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