Grant: Foundation Grant

<html> <body> <p>Misutilization of laboratory tests is one of the largest challenges to the sustainability of health care in Canada, contributing to over one billion dollars in direct costs. There are two main sources of laboratory test misutilization: inappropriately ordered tests and inappropriately repeated tests. Together these make up as much as one third of the workload of clinical laboratories. While all physicians must take ownership for this issue, primary care physicians (family physicians and general practitioners) are uniquely positioned in that they are responsible for 58% of laboratory test costs. Primary care physicians also order the overwhelming majority of tests on community patients, a setting in which strategies to decrease misutilization may have the greatest impact. Despite the importance of this issue, there are remarkably few well-designed studies of utilization management interventions. Additionally, there is a lack of capacity in Canada to analyze the &ldquo;big data&rdquo; sets of laboratory tests currently being generated by clinical laboratories.</p> <p> <br> To address the problem of laboratory test misutilization we have created a unique research platform consisting of a cluster computer and related software capable of analyzing laboratory big data. This platform will be used to analyze a dataset 150 million laboratory tests representing the entire testing history of the city of Calgary since 2008. This research program is built around 2 major objectives. First is the identification of practice variance in test ordering among primary care physicians in Calgary. High variance tests will then be assessed by our primary care knowledge users for potential interventions. Second is the assessment of several known strategies to decrease unnecessary test ordering. This will consist of a cluster randomized trial of a previously validated audit and feedback tool which will show individual physicians their test ordering practices in relation to their peer group. Also under this objective is an observational study of the effect on test order volumes of the Choosing Wisely Canada initiative to reduce unnecessary tests and procedures.</p> <p> <br> Our research team consists of experts in health system research, health economics, statistics, and computer science as well as researchers and knowledge users in family medicine. Key research team linkages exist with the Choosing Wisely Alberta Committee of the Alberta Medical Association and the Alberta Health Services Laboratory Utilization Office. These linkages will facilitate knowledge transfer to both practicing physicians as well as health system administrators. Moreover the results of this research program will be readily transferable to other jurisdictions in their efforts to address this problem.</p> <p> <br> Pathologists, laboratory leaders and health system administrators are ill-equipped to address the issue of laboratory test misutilization. This research program will provide a training ground for these individuals. This research program will leverage not only the existing computing strengths and data availability but will also benefit from ongoing infrastructure support from Alberta Health Services through their funding of the Alberta Laboratory Utilization Office, support and mentorship of the program leader from the O&rsquo;Brien Institute for Public Health at the University of Calgary, and program partnerships with Alberta Innovates- Health Solutions and the Vice President Research office of the University of Calgary.</p> </body> </html>