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A Multimodal Intervention for Reducing Unnecessary Repeat Glycated Hemoglobin Testing.

Jason Baek1, Vamana Rajeswaran2, Susan Tran2

  • 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Canadian Journal of Diabetes
|August 25, 2022
PubMed
Summary
This summary is machine-generated.

A quality improvement initiative successfully reduced unnecessary repeat glycated hemoglobin (A1C) testing. The intervention, involving provider education and automated test cancellation, significantly improved healthcare resource stewardship.

Keywords:
amélioration de la qualitédiabetesdiabètegestion des ressourcesperformance assessmentquality improvementresource stewardshipévaluation de la performance

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Area of Science:

  • Clinical Chemistry
  • Healthcare Quality Improvement
  • Laboratory Medicine

Background:

  • Unnecessary laboratory testing, such as frequent glycated hemoglobin (A1C) tests, diminishes healthcare value.
  • Current guidelines recommend A1C testing every 3 months, yet ordering frequency often exceeds this recommendation.

Purpose of the Study:

  • To implement a quality improvement initiative aimed at reducing unnecessary repeat A1C testing by 75% in a tertiary care academic hospital.
  • To enhance healthcare value by optimizing laboratory test utilization.

Main Methods:

  • A retrospective analysis of 2019 laboratory data identified unnecessary A1C tests (ordered within 60 days).
  • A multifaceted intervention, including provider education and automated cancellation of repeat A1C tests, was implemented in March 2019.
  • Statistical process control charts monitored monthly A1C testing volumes.

Main Results:

  • In 2019, 11% of all A1C tests were deemed unnecessary.
  • From March 2020 to January 2021, 11% of 14,247 A1C tests remained unnecessary, with the intervention successfully cancelling 84% of these.
  • Cardiology and nephrology providers were responsible for over half (55%) of the unnecessary A1C tests ordered.

Conclusions:

  • A dual approach combining gatekeeping and provider education, informed by root-cause analysis, effectively reduces unnecessary A1C testing.
  • This strategy promotes responsible resource stewardship within healthcare systems.
  • Optimizing A1C testing frequency can lead to significant cost savings and improved patient care.