Federal Government announces NHMRC funding of digital health study

Federal Government announces NHMRC funding of digital health study: Abbott is key participant in project to improve use of pathology testing, for improved patient outcomes

Pathology and medical imaging generate information that is crucial to the prevention, diagnosis and treatment of disease, yet errors in diagnosis contribute to 10% of all patient deaths in hospital and many patients leave hospital without receiving the results of their diagnostic tests1.

Macquarie University has been awarded $1 million in National Health and Medical Research Council "Partnership Projects" funding, announced by the Minister for Health and Aged Care, the Hon Greg Hunt, for 'Establishing a digital health foundation for outcomes-based diagnostic excellence, safety and value'2.

The project is led by Professor Andrew Georgiou from the Australian Institute of Health Innovation at Macquarie University. It will build on an existing, highly productive collaboration bringing together Macquarie University researchers with leading clinical researchers from NSW local health districts, NSW Health Pathology, Abbott and the Garvan Institute of Medical Research, among others.

Andrew Georgiou

Professor Georgiou commented, "The project is an exciting research collaboration centring on utilising the enormous potential of digital health to demonstrate innovative and scalable pathways to high value care."

Abbott is a key participant in this study, providing governance oversight, funding, and medical, scientific and project management expertise.

One of the five programs in this study is titled "Establishing a sustainable Sensible Test Ordering Practice (STOP) in hospital acute care settings".

Despite the importance that diagnostic testing plays in the delivery of quality health care3,4, there is evidence of substantial unwarranted variation in diagnostic testing, particularly in hospital EDs and ICUs5,6. Over-testing can lead to a cascade of added investigations resulting in diagnostic errors and unnecessary burden on patients, and under-testing can result in missed diagnoses.

Previous initiatives in this area, such as the Sensible Test Ordering Practice (STOP) initiative, have been developed in Australia to address this issue. STOP involves the use of traffic light systems (green, amber or red) to restrict the range of tests that can be ordered depending on the seniority of the clinician, and while a decrease in test utilisation and significant cost savings were seen after implementation, benefits may not be sustained, mainly because the process relies on manual processes involving support from project officers.

A pilot study using an automated decision support tool in a metropolitan ED demonstrated both significant over-ordering and under-ordering of appropriate pathology test requests.

This program will further develop this automated decision support tool: the intention of the project is to incorporate standardised test request protocols into the tool, integrate it into the hospital EMR for use by ED clinicians at the time of test requesting. The goal is to achieve sustained changes in test ordering behaviour, to improve the value of care in a sustainable manner.

Chris White

Key investigator Professor Chris White, Director of Research at South Eastern Sydney LHD, commented, "We have been working toward sensible test ordering in pathology for some time. It's great to see STOP start."

With a successful outcome, it is thought this model could be easily scaled for state-wide health services to realise similar benefits.

1. Shojania KG, Burton EC, McDonald KM, et al. The autopsy as an outcome and performance measure. Evidence report/technology assessment no. 58. Rockville (MD): Agency for Healthcare Research and Quality. 2002 Oct [cited 2016 Aug 11]. http://archive.ahrq.gov/downloads/pub/evidence/pdf/autopsy/autopsy.pdf
2. Media Release: $472 million investment in Australia's health and medical research future (accessed 16 Sept, 2021)
3. Jha A. World alliance for patient safety-summary of the evidence on patient safety: Implications for research. Spain: World Health Organization 2008
4. Callen J, et al. The safety implications of missed test results for hospitalised patients: a systematic review. BMJ Qual Saf 2011;20(2):194-9. doi: 10.1136/bmjqs.2010.044339 [published Online First: 2011/02/09
5. Wabe N, et al. An evaluation of variation in pathology investigations and associated factors for adult patients presenting to emergency departments with chest pain: An observational study. Int J Clin Pract 2018:e13305. doi: 10.1111/ijcp.13305 [published Online First: 2018/12/15]
6. Spence J, et al. Variation in diagnostic testing in ICUs: a comparison of teaching and nonteaching hospitals in a regional system. Crit Care Med 2014;42(1):9-16. doi: 10.1097/CCM.0b013e3182a63887 [published Online First: 2013/10/23]

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