Improving Management of Outpatient Actionable Test Results

Study Overview
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Brief Summary
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Clinically significant test results require timely clinician follow-up including the non-urgent clinically significant, or actionable, test results that have received less standardized management and attention. Unfortunately, failure to correctly manage actionable test results is not infrequent and may be associated with important delays in diagnosis and treatment and patient harm. The investigators have designed a safe practice intervention to improve the management of actionable test results for ambulatory patients in a large healthcare system.

Official Title
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Improving Management of Outpatient Actionable Test Results

Conditions
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Management of Actionable Test Results (ATRs)

Intervention / Treatment
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* Other: Actionable Test Result Management/Standardization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary care physicians will be enrolled in the study by virtue of being an actively practicing clinician in an PHS ambulatory practice, and having at least one patient with a diagnostic test included in the PHS CCSTR intervention. The patient population will consist of adult patients >17 years of age with diagnostic tests in the affiliated ambulatory practices of PHS. Patients will be recruited into the study by a review of electronic medical record data to identify patients with a diagnostic test specified in the PHS CCSTR intervention. Exclusion Criteria: Participants who do not meet the inclusion/eligibility requirements will be excluded.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Actionable Test Results<br>Creating standardized policies and procedures around actionable test results (ATR) management, and implementing them network-wide: Defining the levels of severity and urgency for clinically significant test results Network-wide policy for test result follow-up by the responsible providers, documentation and escalation processes to assure timely communication. Standardized policies for the time frames and nature of communication of test result alerts. Establish criteria for appropriate ATR management by the responsible provider. Feedback performance including provider, practice and service report cards | Other: Actionable Test Result Management/Standardization<br>* The intervention includes enterprise-wide standardization of actionable test result (ATR) definitions with stratification of significant results into alert levels, expected timeframes for clinician responses, a set of policies for ATR follow-up, metrics to measure ATR management and performance feedback.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acknowledged Sub-Critical/Abnormal ATRs | The primary outcome of interest is the proportion of sub-critical/abnormal (Level 3 Laboratory and Level 2 Cardiology) ATRs documented as acknowledged by the responsible clinician and having appropriate, follow-up action(s). | Acknowledgement within 15 business days from the Level 3 Laboratory ATR alert and acknowledgement within 8 business hours of the cardiology Level 2 ATR alert | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnosis and/or Treatment Delays | The frequency of delays to diagnoses and/or treatment of conditions of interest | Minumum of 3 months post ATR | 
| Undiagnosed/Untreated Condition Frequency and Severity | The frequency and severity of undiagnosed or untreated conditions of interest that occur during the study period. | Minumum of 3 months post ATR |