Reducing the probability of falsely elevated HbA1c results in diabetic patients by applying automated and educative HbA1c re-testing intervals |
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| Institution: | 1. Division of Endocrinology, Diabetes, and Metabolism, University of Florida, Gainesville;2. Department of Internal Medicine, University of Florida, Gainesville;1. Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain;2. Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain;3. Primary Care Center of Mutxamel, Alicante-San Juan Health District, Mutxamel, Alicante, Spain;4. Department of Rheumatology, Hospital Universitario de San Juan, San Juan de Alicante, Spain;5. Department of Pharmacy, Hospital Universitario de San Juan, San Juan de Alicante, Spain;6. Department of Radiology, University of Virginia, Charlottesville, VA, USA |
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| Abstract: | IntroductionToo frequent HbA1c measurements may lead to unnecessary treatment modifications of diabetic patients. The aim of this study was to estimate the percentage of falsely elevated HbA1c results in two hospitals, Landeskrankenhaus/Uniklinikum Salzburg (LKH) and Landesklinik St. Veit (STV), as well as to retrospectively investigate the effect of an automated and an educative 60-day re-testing interval (RTI).MethodsThe amount of estimated falsely elevated results (eFER), based on odds calculated using the baseline and the follow-up values and the time between these measurements, the number of HbA1c re-testings within 60 days as well as the overall number of ordered and performed HbA1c analyses were calculated. In LKH, an automated algorithm cancelling inappropriate HbA1c testing was applied, and in STV, educational actions were taken.ResultsBefore RTI-implementation, eFER were 0.9% and 2.1% and within-60-days-re-testing were 15.0% and 7.4% of cases in LKH and STV, respectively. After RTI-implementation, these numbers decreased to 0.2% (p < .001) and 1.8% (p = .869) and within-60-days-re-testing decreased to 1.1% (p < .001) and 3.6% (p = .003) in LKH and STV, respectively. Median monthly HbA1c measurements decreased by 15.8% (p < .001) and 21.1% (p = .002) in LKH and STV, respectively.ConclusionBoth the educational and the automated 60-day-RTI were proven to be efficient in reducing overall HbA1c measurements, re-testing within 60 days and eFER. |
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| Keywords: | Overuse Overutilisation Demand management Inappropriate laboratory use Gate keeping LKH"} {"#name":"keyword" "$":{"id":"k0035"} "$$":[{"#name":"text" "_":"Landeskrankenhaus/Uniklinikum Salzburg STV"} {"#name":"keyword" "$":{"id":"k0045"} "$$":[{"#name":"text" "_":"Landesklinik St Veit SALK"} {"#name":"keyword" "$":{"id":"k0055"} "$$":[{"#name":"text" "_":"Uniklinikum Salzburg / Salzburger Landeskliniken LIS"} {"#name":"keyword" "$":{"id":"k0065"} "$$":[{"#name":"text" "_":"laboratory information system HbA1c"} {"#name":"keyword" "$":{"id":"k0075"} "$$":[{"#name":"text" "_":"haemoglobin A1c ADA"} {"#name":"keyword" "$":{"id":"k0085"} "$$":[{"#name":"text" "_":"American Diabetes Association NICE"} {"#name":"keyword" "$":{"id":"k0095"} "$$":[{"#name":"text" "_":"UK National Institute for Health and Care Excellence RBC"} {"#name":"keyword" "$":{"id":"k0105"} "$$":[{"#name":"text" "_":"red blood cells RTI"} {"#name":"keyword" "$":{"id":"k0115"} "$$":[{"#name":"text" "_":"re-testing interval |
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