Enhancing pathology test requesting and result management

Background, aims and benefits

Best practice evidence and reliable data are key components required to analyse the quality of pathology requesting and test result management. This project proposes a three stage approach to synthesise best practice evidence and examine the reliability of pathology referral data. In Stage 1 we will obtain ethics approval to undertake analysis of GP pathology referral data, and develop a protocol to carry out a systematic literature review of how GPs interpret and act upon pathology test results. Stage 2 will undertake the systematic review which will involve a comprehensive synthesis of the best available evidence. This evidence will be used to develop and inform initiatives to improve the quality use of pathology. Stage 2 will also undertake an extraction of pathology referral data collected by 50 Australian general practices. These data will be examined and validated to ensure their suitability for analysing the volume and variation of GP pathology referrals. In Stage 3 we will generate a research protocol for a comprehensive study of the quality of pathology requesting and result management in Australian general practice. A final report will also be provided at the end of Stage 3.

Aims

The past decade has seen a dramatic increase in the volume of pathology tests ordered by Australian general practitioners (GPs), amounting to an additional 4 million tests per year. As a result, the cost of diagnostic services rose to $5.3 billion in 2013, raising major concerns about the quality use of pathology and the substantial costs and risks associated with potentially unnecessary tests. This has led to the formation of important international initiatives, such as Choosing Wisely, designed to reduce overutilisation by educating clinicians and patients about current best practice evidence.

Despite the widespread uptake of Choosing Wisely, there is currently no comprehensive approach to measure and assess its impact. The development of such an approach is hindered by a lack of best practice evidence, reliable data and expertise in data management, information systems and quality improvement infrastructures. By combining expertise from these diverse fields, this project aims to:

1. Synthesise the best available evidence of the accuracy with which GPs interpret and act upon pathology results;
2. Assess the reliability of pathology referral data in general practice;
3. Develop a research protocol to examine the quality of pathology requesting and result management in Australian general practice.

The project will be undertaken by the Centre for Health Systems and Safety Research at Macquarie University, in collaboration with the Royal College of Pathologists Quality Assurance Program, Melbourne East GP Network (MEGPN)* and the Health and Biomedical Informatics Centre at the University of Melbourne.

The project will proceed in three stages.

Stage 1: the development of a protocol to undertake a systematic review that will provide a comprehensive overview of the quality of pathology result interpretation in general practice. Ethics approval will also be obtained to proceed with data extraction in Stage 2 of the project.

Stage 2: the systematic review will be undertaken to provide best practice evidence regarding GP interpretation of pathology results. This stage will also involve the extraction of data from 50 practices (574 GPs, 480,000 patients) in MEGPN, which will be examined and validated to assess whether they contain sufficient information to assess the quality of pathology requesting and result management, with results fed back to practices.

Stage 3: a research protocol to examine the quality of pathology requesting and result management in Australian general practice will be developed, and a final report generated.

This project will provide best practice evidence and improve the quality of pathology data. It will also provide a research protocol for a study of the quality of pathology requesting and result management in Australian General Practice. Such a project would provide valuable benchmark data, identify variation and assist the development of external quality assurance programs in the pre and post-analytical phase of the GP pathology interface.

* Melbourne East GP Network (MEGPN) is an independent accredited not-for-profit organisation supporting general practice and other primary healthcare service providers. Previously trading as Inner East Melbourne Medicare Local (IEMML), MEGPN aims to create Australia’s healthiest community.

Benefits

Patients/consumers:

Patients/consumers will benefit from improvements in the care process by means of improved quality of pathology in general practice. To facilitate these improvements in quality, this project will focus on synthesising best practice evidence on pathology referral practices and the management of pathology results. Availability of such data to clinicians, laboratories and primary health networks should enable harmonisation of the way pathology is used in general practice, with a reduction in unnecessary tests and better understanding of the way pathology results can be used to improve the patient’s treatment pathway. The information can also be used to develop and inform initiatives to improve the quality use of pathology. These improvements should in turn improve both the safety and quality of care for patients/consumers.

General Practice:

Pathology services contribute to all branches of medicine. They assist the clinical decision making process and make a critical contribution to the well-being of patients. This project will provide clinicians with best practice evidence regarding the quality of pathology result interpretation. Such information will enable clinicians to analyse their own pathology interpretation practices and, where significant deviations from best practice care are identified, adjust their practices to improve the quality of care that they deliver to their patients.

Pathology laboratories:

Pathology laboratories provide a critical component of patient care. However, referrals for inappropriate or unnecessary tests place a significant burden on pathology services. This project will develop a research protocol to enable the quality of pathology referrals in general practice to be assessed. Such a project has the potential to reduce the number of referrals for inappropriate or unnecessary tests by providing clinicians with benchmark data that relates to the quality of their pathology practices. Furthermore, benchmarking and comparing the use of pathology services is a critical process in the monitoring and quality improvement of services that all organisations should pursue. Performance benchmarks facilitate harmonisation of practice across different sites, which will promote appropriate use of pathology services.

Primary Health Networks:

The analysis of the reliability of pathology referral data collected at different sites across Melbourne East GP Network (MEGPN), will provide important feedback to these sites regarding the quality of their data. Where areas of weakness are identified, changes can be implemented to enhance the quality of pathology data. This information can also be used by other Primary Health Networks (PHNs) to perform a comparison of the quality of their pathology referral data. This information can be used by the PHNs to inform decisions for quality improvement by highlighting areas that may need additional support.

Government Departments of Health: 

This project will develop a research protocol to enable the quality of pathology referrals in general practice to be assessed. Departments of Health can use the benchmark results that would be generated by such a study to influence macro-level decision making and to continually monitor the quality of pathology in general practice, with this information providing valuable indicators of current best practice. Such jurisdiction wide monitoring should lead to a direct improvement in the quality of pathology and should impact favourably on patient outcomes.

Publications

McCaughey E, Li J, Badrick T, Westbrook J, Georgiou A. How well do general practitioners manage laboratory test results for patients with diabetes mellitus and cardiovascular disease?: A systematic review. International Journal for Quality in Health Care. 2017; 29(6):769-78.