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

Quality Assurance for Aboriginal Medical Services (QAAMS) Quality Assurance Program (Current)

Description

This project sought to provide and manage the external quality assurance component of the Quality Assurance for Aboriginal Medical Services (QAAMS) Program, and assist in the provision of training, technical support and quality management to participating Aboriginal and Torres Strait Islander health services across Australia. This report focuses on Cycle 20 which ran from 30 January 2009 to 30 June 2009, and its associated QAAMS activities.

Grant Recipient

Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd (RCPA QAP)

Outcomes

• 
  There were 99 enrolments for cycle 20 comprising of 96 enrolments for glycosylated haemoglobin (HbA1c) and 78 enrolments for urine albumin/creatinine ratio (ACR).
  
• 
  Interim Reports and Supervisor’s Reports were printed monthly as soon as possible after the closing date.
  
• 
  The RCPA QAP and QAAMS management met monthly to review participation, quality control (QC) results and quality assurance (QA) results and decide if any action was required.
  
• 
  The telephone hotline support service is continuing to be used by participants.
  
• 
  The RCPA QAP contributed two newsletters in this reporting period.
  

Findings

• 
  The participation rate of 69% for HbA1c and 64% for urine ACR is an improvement from cycle 19 but still less than in previous years. The Aboriginal Medical Service (AMS) is contacted if they are not participating.
  
• 
  The percentage of acceptable results for HbA1c and urine ACR remained high in cycle 20.
  

Key Project Learnings

• 
  Staff and training are the main issues for the QAAMS’ Quality Assurance Program.
  
• 
  It is a challenge for all participants to return results by the due date. A process has been put into place to alert participants to the consequences of not submitting QC and QA results.
  

Follow on Initiatives and Projects

• 
  Specific funding was provided by the Commonwealth in the 2009 Budget for four years.
  

Areas for Future Consideration

• 
  Further funding for QAAMS will be considered under the new Chronic Disease Prevention and Service Improvement Fund.
  

Communication Strategy and Stakeholder Engagement

The Quality Use of Pathology Program (QUPP) sought to engage stakeholders in pathology through four workshops (Table 12) to scope out issues relating to the quality use of pathology. These workshops identified a number of issues relating to stakeholders within the industry, with the Quality Use of Pathology Committee (QUPC) seeking to increase their engagement with consumers during the latter workshops.

Common issues that emerged during these workshops included:

• 
  workforce safety and quality, especially for Anatomical Pathologists
  
• 
  recruiting and retaining a quality pathology workforce
  
• 
  lack of clear guidelines around pathology requesting and reporting
  
• 
  concerns about eHealth
  
• 
  increased consumer empowerment and engagement
  
• 
  quality assurance issues.
  

These workshops produced many recommendations about the way forward in pathology, while this integrated analysis captured the following areas for future consideration:

• 
  Emphasis should be placed on producing guidelines (perhaps incorporating patient pathways) allowing informed choices to be made by consumers rather than on difficult to develop and administer regulation.
  

• 
  Review the pathology test request forms for relevance to the current provider/requester/consumer climate.
  
• 
  Explore options to develop guidelines/testing pathways, especially for health checks, obesity, common multi-morbidity combinations and hypertension.
  
• 
  Explore options to target requesters at critical education and training points.
  

• 
  Explore the issue of pathology training and specialty opportunities for Aboriginal and Torres Strait Islander medical graduates.
  

• 
  Explore the possibility of developing guidelines on safe pathologist workloads.
  

	Project Name	Grant Recipient/s
1	Report from the National Workshop on Safety and Quality in Pathology (2007)	Michael Legg and Associates
2	The Second National Workshop on Safety and Quality in Pathology (2008)	Michael Legg and Associates
3	Best Practice in Pathology Requesting and Reporting Workshop (2009)	Apis Group Pty Ltd
4	Pathology Workforce Workshop (2011)	URBIS

Table 12: Projects summarised for Communication Strategy and Stakeholder Engagement

Report from the National Workshop on Safety and Quality in Pathology (2007)

Description

This one-day workshop on 28 November 2007 brought together key stakeholders from the pathology profession and industry. They identified a number of key themes for future Quality Use of Pathology (QUPP) investment, including a strong concern about the future safety and quality of pathology as a consequence of current workforce shortages.
Stakeholders represented included:

• 
  Royal College of Pathologists of Australasia (RCPA)
  
• 
  RCPA Quality Assurance Programs Pty Ltd (RCPA QAP)
  
• 
  Australian Association of Pathology Practices (AAPP
  
• 
  National Coalition of Public Pathology (NCOPP)
  
• 
  Consumers Health Forum of Australia (CHF)
  
• 
  National E-Health Transition Authority (NEHTA)
  
• 
  Australian Commission of Safety and Quality in Health Care
  
• 
  Australasian Association of Clinical Biochemists (AACB)
  
• 
  Health Informatics Society of Australia (HISA)
  
• 
  National Association of Testing Authorities (NATA)
  
• 
  ACT Division of General Practice
  
• 
  Cancer Institute of NSW
  
• 
  University of Sydney (GP Statistics and Classification Centre)
  
• 
  Medical Industry Association of Australia
  

Grant Recipient

Michael Legg and Associates

Aims and Objectives

• 
  to focus on the full spectrum of pathology-related quality issues from ‘decision to request a service’ through ‘conduct of the testing’ to ‘use of test results in patient management’
  
• 
  to reflect on current plans and recent pathology initiatives in patient safety and quality
  
• 
  to identify any gaps that need addressing and scan the horizon for future issues
  
• 
  to produce a range of options to guide future development activity in this area contributing to strategic planning for both the short and medium term
  
• 
  to suggest how identified concepts or initiatives should be ranked and priorities for future attention by the relevant bodies.
  

These aims and objectives were achieved by this workshop.

Outcomes

• 
  The Workshop participants identified issues they thought would be important in relation to safety and quality in the provision of pathology services for the next three years. The issues identified in order of priority were:
  

1. 
   workforce (127 points)
   
2. 
   smart requesting (87 points)
   
3. 
   positive identification (63 points)
   
4. 
   testing outside of the current quality framework (46 points)
   
5. 
   smart reporting (44 points)
   
6. 
   multidisciplinary care (25 points)
   
7. 
   clinical audit (14 points).
   

• 
  A Consensus Statement on workforce safety and quality in pathology was developed after the Workshop based on agreement about the pathology workforce issue identified during the Workshop. It could be used to escalate the issue and advocate for remedy. The Consensus Statement developed is:
  

There is a critical threat to the safety and quality of the world-class pathology system that Australia currently has; it is workforce shortages.

The problem extends to the entire range of those involved in providing pathology services but in particular it affects

1. 
   Pathologists and
   
2. 
   Laboratory Scientists/Technicians and Health Informaticians .
   

The shortage of qualified staff is already having an impact on the way that pathology practices are organising themselves and this has been evident for at least the last three years.

The problem is not because of inefficiencies because Australian laboratories are among the most efficient in the world.

There are too few trainees in the system to meet current needs let alone to deal with the ageing workforce.

There are willing trainees and trainers from both public and private practices but there is insufficient state and territory government funding for this education.
The workforce shortage will only be exacerbated by the increased reliance on pathology in the practice of modern medicine and the burgeoning disease burden of an ageing population.
Action by the various parties must be taken now to avoid serious consequences to health outcomes.

Finding

• 
  The current quality framework in pathology laboratories means most risk and opportunity for improvement is in the nodes of the Pathology Request Test Report Cycle in the pre- and post-analytical stages, rather than at the analytical stage.
  

Recommendations

1. 
   Consider options for action to address identified priorities through the Quality Use of Pathology Committee (QUPC) and National Pathology Accreditation Advisory Council (NPAAC).
   
2. 
   Consider reconvening in two years to evaluate progress and revise the plan.
   

Follow on Initiatives and Projects

• 
  The Second National Workshop on Safety and Quality in Pathology