Evaluation of diagnostic safety and quality use of pathology in general practice

Statement of problem: Appropriate and efficient utilisation of pathology testing by General practitioners (GPs) forms a key part of clinical decision-making. However, little is known about how general practice testing compares to disease screening guidelines and best practice. This is due to the difficulty in accessing high-quality datasets, as well as the lack of standardisation between clinical software used by practices, resulting in difficulty combining datasets for research purposes.

Description of intervention/program: Undertaken in collaboration with Outcome Health as data custodian, Primary Health Networks (PHNs) and the Royal College of Pathologists of Australasia Quality Assurance Programs, the key objective of the program was to identify variation in pathology requests in general practice in the context of best practice guidelines to inform the quality and safe use of pathology in general practice and improve patient outcomes.

The research program drew from de-identified, standardised and longitudinal patient data generated from various clinical information systems in three PHNs across Victoria, available via a secure digital health platform provided by Outcome Health. Key laboratory tests of interest were selected based on consultations with experts and stakeholders and informed by best practice guidelines.

Findings to date:
HbA1c and kidney function for type 2 diabetes monitoring: Most patients (71%-81%) received annual kidney function testing as recommended by guidelines. However, improvement in follow-up HbA1c testing was required in patients who had results outside the recommended HbA1c level (>53mmol/mol), where the overall median time interval was 4.7 months (IQR: 3.5–6.6 months) and longer than the recommended three months.

Vitamin D testing: We found an increase in the proportion of patients having vitamin D testing from 8% in 2014 to 11% in late 2018. We observed lower proportions of vitamin D tests with low test results in summer months (15-20%) compared to winter months (30-35%), potentially demonstrating lower value testing during the warmer months. We also observed high variation in Vitamin D testing among practices within PHNs, suggesting a lack of consensus regarding vitamin D testing.

Lessons learned: The program integrates elements of informatics (the translation data into information and knowledge to improve delivery of health care services) and research co-design to create a pathway for translation of results into practice. The use of program results by PHNs in the design of quality improvement activities have the potential to make a significant impact on both GP test result management activities and patient outcomes.

Disclosure of Interest Statement:
This project was funded by a Department of Health Quality Use of Pathology Program. The authors declare no competing interests.