IgE allergy testing utilization: Implementation of a provincial quality improvement initiative

Allergen specific IgE (sIgE) testing plays a critical role in the diagnosis of allergic disease. However, inappropriate utilization of sIgE testing, including ordering screens or panels of allergens not guided by the patient's history, can cause substantial harm and waste valuable healthcare resources. Here, we aimed to roll-out and assess the impact of a province-wide initiative in Alberta, Canada to align with clinical practice guidelines and reduce inappropriate ordering of sIgE testing.

Educational materials were distributed, followed by discontinuation of the food screen and reflex panels for both food and inhalant allergens. Four years of provincial sIgE testing volumes were analyzed centered around the key utilization changes. Testing volumes were normalized to the top ordered tests in the healthcare system and interrogated by both allergen category and provider type (non-allergy specialist versus allergy specialist).

A 37.1% decrease in normalized total sIgE testing volumes was achieved in the first year after the utilization changes, with subsequent increases leading to a sustained 31.7% decrease compared to the year prior to the changes. Inhalant allergen testing showed a more dramatic and sustained decrease compared to food allergens. The primary ordering provider of sIgE testing in the province flipped over the course of the project from non-allergy specialists to allergy specialists. The number of sIgE orders per patient encounter by non-allergy specialists shifted from primarily one or two (before) to one or five (after).

Aligning with clinical practice guidelines decreased the volume of sIgE testing on a provincial scale and shifted the primary ordering provider of this complex testing to allergy specialists. Additional efforts are needed to further promote targeted ordering of clinically useful tests.