Integrated Analysis of Quality Use of Pathology Program (qupp) Final Reports

Executive Summary

The Quality Use of Pathology Program (QUPP) is a well-established program having been established in 1999. Its goal is the continual improvement in health and economic outcomes from the use of pathology in health care through the pursuit of better practice amongst requesters/referrers and providers of pathology services, and through knowledgeable and engaged consumers. It is managed by the Australian Government Department of Health and Ageing (DoHA) in conjunction with the Quality Use of Pathology Committee (QUPC).

The Australian Government Department of Health and Ageing commissioned Cognitus Pty Ltd to undertake an analysis of the projects/ initiatives funded under the Quality Use of Pathology Program (QUPP). The objectives of the project were:

• 
  to conduct a comprehensive review of QUPP projects/initiatives , including project results and recommendations; and
  
• 
  to produce a document that would record the past and present investment and could inform the future strategic direction of the program.
  

This analysis includes a summary of the QUPP projects/ initiatives over the past ten years and also provides an analysis of whether each of the projects/ initiatives achieved their aims and objectives and whether there were any key project learnings.

There were 74 project reports analysed, which were further divided into the following nine themes that were based on QUPP areas of focus:

1. 
   Promoting Evidence-Based Practice
   
2. 
   Risk Minimisation
   
3. 
   Quality Assurance and Capacity – New Technology
   
4. 
   eHealth Capability
   
5. 
   Pathology Requesting and Reporting – Requester and Consumer Focus
   
6. 
   Workforce Capacity and Competence
   
7. 
   Consumer Focus and Information Strategies
   
8. 
   Access Initiatives – Raising Awareness
   
9. 
   Communication Strategy and Stakeholder Engagement.
   

The number of reports within each theme is presented in Figure 1.

Figure – Report numbers by Category

[alt = ‘This figure is a graph representing the number of reports under each of the nine themes’]

General Findings from the Analysis

The QUPP has contributed to the expansion of the knowledge base of pathology practice and to the quality use of pathology services in Australia. There were a number of project recommendations that were strategically followed up in subsequent projects. For example, The Australian Pathology Workforce Crisis report resulted in five other initiatives and projects.
In a broader sense, all of the themes led to a high rate of follow on initiatives and projects as outlined below:

Theme	Original projects	Follow on initiatives and projects
Pathology Requesting and Reporting – Requester and Consumer Focus	17	9
Promoting Evidence-Based Practice	16	10
eHealth Capability	12	9
Quality Assurance and Capacity – New Technology	8	4
Workforce Capacity and Competence	6	10
Risk Minimisation	5	4
Communication Strategy and Stakeholder Engagement	4	4
Consumer Focus and Information Strategies	3	4
Access Initiatives – Raising Awareness – 2 out of 3	3	2

Table 1: Summary of Follow On Initiatives and Projects
Areas of significant and rapid change, such as eHealth have been supported to enable investigation into their impact on the quality use of pathology including health and economic outcomes. For example, twelve projects in the area of eHealth have uncovered significant key project learnings such as issues with software installation and capacity, and identified strategies to facilitate the future implementation of eHealth capability.
The QUPP investment into eHealth also enabled pathology reports to integrate into the electronic age by supporting projects to develop software systems to automatically extract information from narrative pathology reports, and to standardise pathology terminology units to facilitate their use in electronic reporting.
Projects to investigate workforce issues in the pathology sector were also funded by this program. These projects identified stakeholder concerns, such as the ageing pathology workforce and the lack of a structured career path for scientists. Of the six projects funded under the Workforce Capacity and Competence theme, ten follow on projects and initiatives have been undertaken to further investigate and address these key issues.
The QUPP also facilitated increased engagement with consumers through workshops which highlighted issues predominantly based on a need for improved communication and engagement, and the need for comprehensive information strategies to address consumer concerns.
From the analysis of QUPP initiatives to date, there are few identified areas that may benefit from some further consideration. These include:

• 
  eHealth information outlining the benefits/risks of pathology results being uploaded onto the National Electronic Health Record System for consumers.
  
• 
  Standardised request forms and education of all levels of health practitioners about the importance of completing the information on these forms.
  

• 
  Development of comprehensive guidelines for General Practitioners (GPs) regarding evidence-based pathology requesting.
  
• 
  Investigate including patient-specific advice for GPs on pathology test results.
  
• 
  Focus on increasing GPs’ understanding of the pathology testing process.
  

Consistent Themes Identified from the Analysis

From the analysis there appears to be three consistent themes throughout all areas of the pathology spectrum. These are:

1. 
   The need for increased information resources generated by reliable sources about pathology testing for General Practitioners (GPs) that are short, concise and easily accessed. This information should also include procedures for GPs when collecting pathology specimens from their patients, and for GPs to give to their patients for patient-collected samples.
   
2. 
   Educating medical students during their training and post-graduate years about pathology was consistently viewed as a long term strategy to improve pathology knowledge and practice. This included rotating medical students through pathology laboratories as a component of their medical training.
   

3. 
   Producing reliable consumer information about pathology testing, and keeping consumers informed about current issues/advances within pathology.
   

Conclusion

The QUPP has enabled projects to investigate and implement improvements in health and economic outcomes for the quality use of pathology. This is evidenced by the high rate of follow on initiatives and projects outlined in Table 1, and by the changes in practice that have resulted from this program’s support. For example, the Structured Pathology Reporting of Cancer projects developed cancer protocols for the structured reporting of six types of cancer. This project may lead to the possible development of a standardised reporting format for all major cancers and other major complex reporting topics.
This integrated analysis also highlighted a number of key project learnings from the past ten years of the Quality Use of Pathology Program. It also identified potential areas for future consideration across all of the themes which are presented in the analysis of each theme. This report stands as a record of the valuable investment the program has made to the quality and capacity of the pathology sector to date, and will form the basis for reflection when future programs are investigated and/or supported by this important program.