Management of Actionable Test Results (ATRs)
Conditions
Brief summary
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.
Interventions
OTHERActionable Test Result Management/Standardization
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.
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Brigham and Women's Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Acknowledged Sub-Critical/Abnormal ATRs | 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 | 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). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diagnosis and/or Treatment Delays | Minumum of 3 months post ATR | The frequency of delays to diagnoses and/or treatment of conditions of interest |
| Undiagnosed/Untreated Condition Frequency and Severity | Minumum of 3 months post ATR | The frequency and severity of undiagnosed or untreated conditions of interest that occur during the study period. |
Countries
United States
Outcome results
None listed