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St. Joseph's Health Centre Toronto

New tool helps practitioners evaluate their testing rates

By Emily Dawson

An interprofessional research team at St. Joseph’s recently launched the Best Practices in Medicine (BPiM) project, which marries a personalized audit and an online learning tool to help practitioners ‘right-size’ their laboratory and diagnostic imaging test utilization rates.

“The impact of over-utilization on health-care costs and patient care has been a hot topic in the medical community,” says Dr. Ajay Kapur, chief medical information officer at St. Joseph’s. “We saw an opportunity to help practitioners reflect on their own practices and offer education to support behavioural changes.”

A key differentiator of the St. Joseph’s research is that it examines both over-utilization and under-utilization and it occurs in a community hospital.

“While not as widely discussed, under-utilization of tests is also cause for concern. It can result in insufficient information being available for diagnosis and patients not receiving appropriate care,” explains Elizabeth Wooster, research associate in St. Joseph’s Department of Medical Education and Scholarship.

The research team started with two commonly ordered tests: Thyroid Stimulating Hormone and Vitamin D. Using data collected through hospital records, the team stratified the data to present 66 practitioners with a personal “scorecard” comparing their own order rates within a specific period against the entire hospital, their department, and their division.

After reviewing their results, practitioners can voluntarily take an e-learning course about best practices in test ordering.

“This is about guided self-reflection with a goal to improve patient care,” says Wooster. “The purpose is to ensure that the right test is ordered for the right patient, at the right time.”

Dr. Kapur says the feedback about the project has been excellent.

“The majority have said this is a useful tool. Even if people choose not to complete the e-learning, they’re talking about it and informally learning from each other,” he says, adding he’s excited by the opportunities to leverage BPiM for other tests, and across health disciplines.

“The BPiM methodology can be applied to any aspect of patient care. Now we can focus on expanding it beyond the department of medicine.”

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