Ma Irene, Guo Maggie, Viczko Jeannine, Naugler Christopher
Departments of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Canada.
Calgary Laboratory Services, Calgary, Alberta, Canada.
Clin Biochem. 2017 Dec;50(18):1253-1255. doi: 10.1016/j.clinbiochem.2017.09.003. Epub 2017 Sep 8.
The Canadian Diabetes Association recommends testing most individuals with diabetes mellitus using HbA1c once every 3months. In Alberta, Canada, a provincial intervention to reduce inappropriate HbA1c test orders was implemented to align with this guideline, where only one HbA1c test request every 90days for most individuals can be processed. Here, we evaluated the provincial intervention to reduce redundant HbA1c testing in Alberta.
Total counts of all HbA1c tests ordered within Edmonton and Calgary, Alberta, were collected from the respective Laboratory Information Systems each month between January 2013 and December 2016. Winters' Additive time series model was built to predict the HbA1c test volume after intervention (November 1, 2015 onwards) and compared with the observed test volume to estimate the effect of the intervention. The estimated change in test volume was then multiplied by the estimated cost to determine the economic impact.
During the first 14months of the intervention for Alberta, there was a 3.3% reduction in the number of observed HbA1c tests compared to the predicted volume. With an estimated marginal reagent cost of $3.50 per unit, this resulted in a cost savings of $145,422 in the first 14months of the provincial intervention.
A modest reduction in HbA1c test orders was observed in the urban areas of Alberta since the implementation of this provincial initiative.
加拿大糖尿病协会建议大多数糖尿病患者每3个月检测一次糖化血红蛋白（HbA1c）。在加拿大艾伯塔省，实施了一项省级干预措施以减少不适当的HbA1c检测医嘱，以符合该指南，即大多数人每90天只能处理一次HbA1c检测申请。在此，我们评估了艾伯塔省减少重复HbA1c检测的省级干预措施。
2013年1月至2016年12月期间，每月从艾伯塔省埃德蒙顿和卡尔加里各自的实验室信息系统中收集所有HbA1c检测的总计数。建立温特斯加法时间序列模型来预测干预后（2015年11月1日起）的HbA1c检测量，并与观察到的检测量进行比较，以评估干预效果。然后将估计的检测量变化乘以估计成本来确定经济影响。
在艾伯塔省干预的前14个月，观察到的HbA1c检测数量比预测数量减少了3.3%。估计每单位试剂边际成本为3.50美元，这导致在省级干预的前14个月节省了145,422美元的成本。
自该省级倡议实施以来，艾伯塔省城市地区的HbA1c检测医嘱出现了适度减少。
