NSW Health Pathology, Sydney, New South Wales, Australia.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
BMJ Open. 2020 Oct 12;10(10):e039437. doi: 10.1136/bmjopen-2020-039437.
Variation in test ordering is a major issue in Australia and globally with significant financial and clinical impacts. There is currently a lack of research identifying and remediating variation in the use of pathology tests in emergency departments (EDs). In 2019, NSW Health Pathology introduced the Pathology Atlas of Variation that uses a data-driven tool (the Atlas Analytical Model) to investigate test order variation across New South Wales (NSW) and engage with local health districts (LHDs) to reduce variation. The objectives of this study are to evaluate whether this data-driven approach is associated with: (1) a reduction in test order variation; (2) improvements in patient outcomes and (3) cost benefits, for the five most frequent ED presentations.
This is a large multisite study including 45 major public hospitals across 15 LHDs in NSW, Australia. The Atlas Analytical Model is a data analytics and visualisation tool capable of providing analytical insights into variation in pathology investigations across NSW EDs, which will be used as feedback to inform LHDs efforts to reduce variation. Interrupted time series analyses using 2 years pre Atlas (2017-2018) and 2 years post Atlas (2021-2022) data will be conducted. Study data will be obtained by linking hospital and laboratory databases. Funnel plots will be used to identify EDs with outlying pathology test ordering practices. The outcome measures include changes in test ordering practices, ED length of stay, hospital admission and cost benefits (total pathology costs per ED encounter).
The study has received ethical approval from the NSW Population and Health Service Research Ethics Committee (reference, 2019/ETH00184). The findings of the study will be published in peer-reviewed journals and disseminated via presentations at conferences. We will also engage directly with key stakeholders to disseminate the findings and to inform policies related to pathology testing in the ED.
在澳大利亚和全球范围内，检测订单的变化是一个主要问题，这对财务和临床都有重大影响。目前，缺乏针对急诊部（ED）病理检测使用差异进行识别和纠正的研究。2019 年，新南威尔士州卫生病理学推出了 Pathology Atlas of Variation，该方法使用数据驱动工具（Atlas Analytical Model）来调查新南威尔士州各地的检测订单变化，并与当地卫生区（LHD）合作以减少差异。本研究的目的是评估这种数据驱动方法是否与以下方面相关：（1）检测订单变化减少；（2）患者结果改善；（3）五个最常见 ED 表现的成本效益。
这是一项大型多站点研究，包括澳大利亚新南威尔士州 15 个 LHD 的 45 家主要公立医院。Atlas Analytical Model 是一种数据分析和可视化工具，能够为新南威尔士州 ED 病理学调查中的变异性提供分析见解，这将作为反馈信息，为 LHD 减少变异性的努力提供信息。将使用 2 年 Atlas 前（2017-2018 年）和 2 年 Atlas 后（2021-2022 年）的数据进行中断时间序列分析。通过链接医院和实验室数据库获取研究数据。将使用漏斗图来识别 ED 中具有异常病理检测订购实践的 ED。结局指标包括检测订购实践的变化、ED 住院时间、住院和成本效益（每个 ED 就诊的总病理成本）。
该研究已获得新南威尔士州人口和卫生服务研究伦理委员会的伦理批准（参考号，2019/ETH00184）。研究结果将发表在同行评议的期刊上，并通过会议报告进行传播。我们还将直接与主要利益相关者合作，传播研究结果，并为 ED 中的病理检测相关政策提供信息。
