A Multimodal Intervention for Reducing Unnecessary Repeat Glycated Hemoglobin Testing

Objectives: Reducing unnecessary tests that do not enhance quality can promote health-care value. Glycated hemoglobin (A1C) is often ordered at a frequency exceeding the recommendation of once every 3 months. We conducted a quality improvement (QI) initiative aimed to reduce unnecessary repeat testing by 75% at a tertiary care academic hospital.Methods: A retrospective baseline analysis was conducted on laboratory data from 2019 that enumerated unnecessary A1C tests, defined as repeat tests ordered within 60 days. A multifaceted change inter-vention with iterative plan-do-study-act cycles was introduced in March 2019 to educate providers and to automatically cancel A1C tests requested within 60 days. Monthly totals of A1C testing processed were plotted on statistical process control charts.Results: In 2019, 11% of all A1C tests ordered were unnecessary. Between March 2020 and January 2021, 11% of the tests (N=14,247 tests) were unnecessary, of which 84% were cancelled with our intervention. Providers in cardiology and nephrology accounted for over half (55%) of the unnecessary tests ordered.Conclusions: A 2-pronged approach informed by root-cause analysis, and comprised of gatekeeping and provider education, can effectively promote resource stewardship for reducing unnecessary A1C testing.(c) 2022 Canadian Diabetes Association.

Automated summary

This study aimed to reduce unnecessary repeat A1C testing through a quality improvement initiative. The results showed that after the intervention, unnecessary testing decreased by 84%. By using root-cause analysis and provider education, resource stewardship can be effectively promoted to reduce unnecessary A1C testing.