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



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








A Summary Report for the

Australian Department of Health and Ageing

Medical Benefits Division






Canberra

22 June 2012






Cognitus Pty Ltd


Jane Carstens

Table of Contents


Integrated Analysis of Quality Use of Pathology Program (QUPP) Final Reports 1

A Summary Report for the 1

Australian Department of Health and Ageing 1

Medical Benefits Division 1

Canberra 1



22 June 2012 1

Cognitus Pty Ltd 1

Table of Contents 2

Executive Summary 3



General Findings from the Analysis 4

Consistent Themes Identified from the Analysis 5

Conclusion 5

Abbreviations 7

Introduction 8



Background 8

Promoting Evidence-Based Practice 11

Evaluation of the Impact on Pathology Practice of the Manual of Use and Interpretation of Pathology Tests (2001) 13



Description 13

Grant Recipient 13

Aims 13

Objectives 14

Findings 14

Recommendations 15

Key Project Learnings 16

Follow on Initiatives and Projects 16

Areas for Future Consideration 16

Revision of Manual of Use and Interpretation of Pathology Tests (2004) 16



Description 16

Grant Recipient 16

Aim 16

Findings 17

Recommendations 17

Key Project Learning 17

Follow on Initiatives and Projects 17

RCPA Manual Transformation Project (2010) 18



Description 18

Grant Recipient 18

Aims and Objectives 18

Outcomes 18

Finding 18

Recommendation 18

Key Project Learning 19

Areas for Future Consideration 19

An Historical Analysis of Pathology Ordering by General Practitioners between April 1998 and March 2001 from the Bettering the Evaluation and Care of Health (BEACH) Program (2002) 19



Description 19

Grant Recipient 19

Aims and Objectives 19

Findings 20

Key Project Learnings 20

Follow on Initiatives and Projects 21

Evidence-Practice Gap in GP Pathology Test Ordering: A Comparison of BEACH Pathology Data and Recommended Testing (2009) 21



Description 21

Grant Recipient 21

Aims and Objectives 21

Findings 22

Recommendations 22

Key Project Learnings 23

Follow on Initiatives and Projects 24

Areas for Future Consideration 24

A Project to Examine the Utilisation of Pathology Tests in the Investigation of Tiredness in General Practice (2002) 24



Description 24

Grant Recipient 24

Aim 24

Objectives 24

Findings 25

Recommendations 25

Key Project Learnings 26

Areas for Future Consideration 26

Analysis of Current Practices in Relation to the Teaching of Pathology (Laboratory Medicine) (2003) 26



Description 26

Grant Recipient 26

Aims and Objectives 26

Findings 26

Recommendations 27

Follow on Initiatives and Projects 28

Areas for Future Consideration 28

Analysis of Current Laboratory Medicine (Pathology) Teaching Practice in Prevocational and General Practitioner Vocational Training (2003) 28



Description 28

Grant Recipient 28

Aims and Objectives 28

Findings 28

Recommendations 30

Follow on Initiatives and Projects 31

Areas for Future Consideration 32

A Mechanism for the Development, Implementation and Evaluation of Evidence-Based, Best-Practice Clinical Guidelines to Facilitate Quality Use of Pathology Tests (2003) 32



Description 32

Grant Recipient 32

Aim 32

Findings 32

Recommendations 33

Areas for Future Consideration 33

Academic Detailing Supporting Better Outcomes from Diagnostic Technologies (2004) 33



Description 33

Grant Recipient 34

Aims and Objectives 34

Findings 34

Recommendations 35

Key Project Learnings 36

Follow on Initiatives and Projects 36

Common Sense Pathology (2006) 36



Description 36

Grant Recipient 36

Aim 36

Outcomes 36

Findings 37

Recommendation 37

Key Project Learnings 37

Follow on Initiatives and Projects 37

Common Sense Pathology Publication Series (2011) 37



Description 37

Grant Recipient 38

Aims and Objectives 38

Outcomes 38

Findings 38

Improved Pathology Reporting, Education and Practice (IPREP) for Colorectal Cancer (2009) 38



Description 38

Grant Recipient 38

Aims and Objectives 38

Outcomes 39

Follow on Initiatives and Projects 39

Structured Pathology Reporting Standards for Cancer (2009) 39



Description 39

Grant Recipient 39

Aim 40

Outcomes 40

Key Project Learnings 40

Follow on Initiatives and Projects 40

Promoting and Expanding Structured Pathology Reporting of Cancer (Stage 2) (Current) 40



Description 40

Grant Recipient 40

Aims and Objectives 40

Outcomes 41

Areas for Future Consideration 41

Evidence-Based, Best-Practice Prevention of Blood Borne Virus Transmission in Health Care Settings Program (PBBV) (2009) 41



Description 41

Grant Recipient 41

Aims and Objectives 41

Outcomes 42

Recommendations 42

Key Project Learning 42

Follow on Initiatives and Projects 42

Risk Minimisation 43

RCPA – Quality Assurance Programs Key Indicator Project (2004) 43



Description 43

Grant Recipient 44

Aims and Objectives 44

Outcomes 44

Findings 46

Recommendations 46

Key Project Learnings 47

Follow on Initiatives and Projects 47

Pilot Laboratory Assessment and Peer Review Mechanism for Pathology Key Performance Indicators (2007) 47



Description 47

Grant Recipient 48

Aims and Objectives 48

Outcome 48

Findings 48

Recommendations 49

Key Project Learning 49

Follow on Initiatives and Projects 50

Performance Monitoring of External Quality Assurance (Current) 50



Description 50

Grant Recipient 50

Aim 50

Objectives 50

Outcomes 50

NATA File Audit – Risk Analysis of Assessment Non Conformances Identified in Pathology Laboratory Assessment Accreditation (Current) 51



Description 51

Grant Recipient 51

Aims and Objectives 51

Outcome 51

Key Incident Monitoring & Management Systems (Current) 51



Description 51

Grant Recipient 52

Objectives 52

Outcomes 52

Findings 52

Recommendations 53

Key Project Learnings 53

Follow on Initiatives and Projects 54

Areas for Future Consideration 54

Quality Assurance and Capacity – New Technology 55

Virtual Microscope (2005) 56



Description 56

Grant Recipient 56

Aims and Objectives 56

Outcomes 56

Findings 57

Key Project Learning 57

Follow on Initiatives and Projects 57

High Resolution Scanning Microscopy for Quality Assurance and Educational Applications (2009) 57



Description 57

Grant Recipient 57

Aims and Objectives 57

Outcomes 57

Development of a Quality Assurance Module for Human Papilloma Virus Testing (2008) 58



Description 58

Grant Recipient 58

Aims and Objectives 58

Outcomes 58

Findings 59

Recommendations 59

Preparing for Genomic Medicine: National Audit and Development of a Best Practice Approach (2009) 59



Description 59

Grant Recipient 59

Aims and Objectives 59

Outcomes 60

Follow on Initiatives and Projects 60

The catalogue of genes, genetic tests and genetic laboratories was established as a component within the 60



Areas for Future Consideration 60

Policies, Procedures and Guidelines for Point-of-Care Testing (2011) 60



Description 60

Grant Recipient 60

Aims and Objectives 60

Findings 60

Follow on Initiatives and Projects 62

Areas for Future Consideration 62

PoCT Training, Certification, Support and Skill Maintenance Program (Australian PoCT Practitioners Network – APPN) (Current) 62



Description 62

Grant Recipient 62

Aim 62

Outcomes 62

Establishment of a Molecular Genetics Quality Assurance Program (Current) 63



Description 63

Grant Recipient 63

Aim 63

Objectives 63

Outcomes 64

MAWSON – An Online Repository of Genetic Data to Aid Reporting of Medical Genetic Tests (Current) 64



Description 64

Grant Recipient 64

Aim 64

Outcomes 64

Areas for Future Consideration 65

eHealth Capability 66

Pathology Informatics Working Party (2003) 67



Description 67

Grant Recipient 68

Aims and Objectives 68

Outcomes 68

Findings 68

Follow on Initiatives and Projects 68

Development of on On-line Maintenance System for the Australian Pathology Request and Result Code Sets (2003) 69



Description 69

Grant Recipient 69

Aims and Objectives 69

Outcomes 69

Recommendations 70

Key Project Learning 70

Follow on Initiatives and Projects 70

Pathology and General Practice Software Integration Project (PaGSIP) (2003) 70



Description 70

Grant Recipients 70

Aims and Objectives 70

Findings 70

Recommendations 71

Key Project Learnings 71

Follow on Initiatives and Projects 72

Areas for Future Consideration 72

Chain of Information Custody for the Pathology Request-Test-Report Cycle in Australia (Guidelines for Pathology Requesters and Pathology Providers) (2004) 72



Description 72

Grant Recipient 72

Aims 72

Outcome 73

Follow on Initiatives and Projects 73

Supporting HL7 for Health Informatics Standards (2004) 73



Description 73

Grant Recipient 73

Aims and Objectives 73

Outcomes 73

Finding 73

Follow on Initiatives and Projects 73

A Study of the Impact of the Use of General Practice Computer Systems on the Ordering of Pathology (2004) 74



Description 74

Grant Recipients 74

Aim 74

Outcomes 74

Findings 74

Recommendation 76

Key Project Learning 76

Areas for Future Consideration 77

Application of Pathology Informatics to Reporting of Critical/Abnormal Results for Improved Requester/Provider Communication and Improved Patient Care (2004) 77



Description 77

Grant Recipient 77

Aims and Objectives 77

Outcomes 78

Finding 78

Recommendations 78

Key Project Learnings 78

Padlok On-line Pathology Ordering System (2005) 79



Description 79

Grant Recipient 79

Aims and Objectives 79

Outcomes 79

Findings 79

Recommendations 80

Key Project Learnings 80

Areas for Future Consideration 81

Information Extraction from Narrative Pathology Reports on Melanoma (2008) 81



Description 81

Grant Recipient 81

Aims and Objectives 81

Findings 81

Recommendation 82

Key Project Learnings 82

Follow on Initiatives and Projects 82

Automatic Compilation of Synoptic Reports from Narrative Pathology Reports (Stage 2) (2010 Submitted with the title: The Pathology Reporter) 82



Description 82

Grant Recipient 82

Aims and Objectives 82

Outcome 83

Findings 83

Recommendation 83

Key Project Learning 83

Follow on Initiatives and Projects 83

Areas for Future Consideration 83

Automatic Population of Synoptic Reports from Narrative Pathology Reports (Stage 3) (Current) 83



Description 83

Grant Recipient 83

Aims and Objectives 83

Recommendation 84

Standardisation of Pathology Terminology and Units (Current) 84



Description 84

Grant Recipient 84

Aims and Objectives 84

Pathology Requesting and Reporting – Requester and Consumer Focus 85

Guidelines for Patient/Consumer Access to Pathology Test Reports (2001) 87



Description 87

Grant Recipient 87

Aim 87

Findings 87

Recommendations 88

AUSLAB Retest Interval Trial Project (2003) 89



Description 89

Grant Recipient 89

Aims 89

Outcomes 89

Findings 90

Recommendations 90

Key Project Learnings 90

Follow on Initiatives and Projects 91

AUSLAB Retest Interval Project (2004) 91



Description 91

Grant Recipient 91

Aim 91

Outcomes 91

Findings 91

Key Project Learnings 92

Area for Future Consideration 92

Home Monitoring of Warfarin Therapy in Children using the CoaguchekTM Point of Care INR Monitor (2003) 93



Description 93

Grant Recipients 93

Aim 93

Outcomes 93

Findings 93

Recommendation 94

Key Project Learning 94

Follow on Initiatives and Projects 94

Facilitating Best Practice Pathology Utilisation by the Use of Hand-Held Decision Support Devices (2004) 94



Description 94

Grant Recipient 94

Aims 94

Objectives 94

Outcomes 95

Findings 97

Recommendations 97

Key Project Learnings 98

Follow on Initiatives and Projects 99

Area for Future Consideration 99

Improving GP Access to and Use of Retrospective and Current Pathology Data to Increase Detection of Early Diabetes (IGT and IFG) in General Practice (2005) 100



Description 100

Grant Recipient 100

Aims and Objectives 100

Outcomes 100

Findings 101

Recommendations 101

Key Project Learnings 102

Areas for Future Consideration 103

Quality Use of Pathology Services Education Program (2006) 103



Description 103

Grant Recipient 103

Aims and Objectives 104

Outcomes 104

Findings 104

Recommendations 105

Key Project Learnings 105

Areas for Future Consideration 105

Investigation into the Reasons for Incorrect or Incomplete Pathology Request Forms (2008) 105



Description 105

Grant Recipient 106

Aims 106

Outcomes 106

Findings 106

Recommendations 107

Follow on Initiatives and Projects 107

Areas for Future Consideration 107

Enhancing the Quality Use of Pathology for GP Registrars and International Medical Graduates – Assessing the Need (2009) 108



Description 108

Grant Recipient 108

Aim 108

Objectives 108

Outcomes 108

Findings 109

Recommendations 111

Follow on Initiatives and Projects 112

Areas for Future Consideration 112

Effect of a Structured Microbiology Laboratory Report on Antimicrobial Prescribing for Asymptomatic Bacteriuria in Elderly Females (2010) 112



Description 112

Grant Recipients 112

Aim 113

Outcomes 113

Findings 113

Recommendations 114

Areas for Future Consideration 114

Identifying how Electronic Decision Support (EDS) in Computerised Pathology Order Entry Systems can Improve Pathology Practice, Rational Ordering and Patient Outcomes (2010) 114



Description 114

Grant Recipient 115

Aims and Objectives 115

Outcomes 115

Findings 116

Recommendations 116

Follow on Initiatives and Projects 116

The Impact of the Implementation of Electronic Ordering of Pathology Requesting and the Quality and Effectiveness of Hospital Pathology Services – Building a Robust Evidence Base and Benefits Framework for Successful e-Health Diffusions (Current) 117



Description 117

Grant Recipient 117

Aim 117

Objectives 117

Outcomes 117

Computer Assisted Patient Simulations for Education in the Rational Use of Investigations – Final Report for Phase 1 (iNvestigate Project) (2010) 118



Description 118

Grant Recipient 118

Aim 118

Outcomes 118

Recommendations 119

Key Project Learnings 119

Follow on Initiatives and Projects 119

iNvestigate: Online Patient Simulations for Education in the Rational Use of Investigations – Final Report for Phase 2 (2011) 119



Description 119

Grant Recipient 120

Aims and Objectives 120

Outcomes 120

Finding 120

Recommendations 120

Key Project Learnings 121

Follow on Initiatives and Projects 121

Areas for Future Consideration 121

iNvestigate: Online Patient Simulations for Education in the Rational Use of Investigations (Current) 121



Description 121

Grant Recipient 121

Aims 121

Outcomes 121

Encouraging Quality Pathology Ordering in Australia’s Public Hospitals (2011) 122



Description 122

Grant Recipient 122

Aims and Objectives 122

Outcomes 122

Findings 124

Recommendations 126

Key Project Learning 127

Areas for Future Consideration 127

Effective Communication of Pathology Results in Requesting Practitioners and Consumers (Current) 127



Description 127

Grant Recipients 127

Aims 127

Outcomes 127

Workforce Capacity and Competence 129

PathWay (2005) 130

The Australian Pathology Workforce Crisis (2008) 131

Description 131

Grant Recipient 131

Review of Pathology Specialist Development Pathways (2010) 137



Description 137

Grant Recipient 137

Impact of Workload of Anatomical Pathologists on Quality and Safety (2011) 141



Description 141

Grant Recipient 142

Survey of the Pathology Workforce (2011) 144



Description 144

Grant Recipient 144

Career Structures and Pathways for the Scientific Workforce in Medical Pathology Laboratories (2011) 148



Description 148

Grant Recipient 148

Consumer Focus and Information Strategies 152

Quality Use of Pathology Consumer Consultation Project (2010) 152



Description 152

Grant Recipient 152

Benefits and Risks of Pathology Testing (Current) 154



Description 154

Grant Recipient 155

Lab Tests OnlineAU Stage 1 (Current) 155



Description 155

Grant Recipient 155

Access Initiatives – Raising Awareness 157

Optimising Health Benefits for Aboriginal People who take Warfarin (2009) 158

Description 158

Grant Recipient 158

Quality Assurance for Aboriginal Medical Services (QAAMS) (Current) 160



Description 160

Grant Recipient 160

Quality Assurance for Aboriginal Medical Services (QAAMS) Quality Assurance Program (Current) 163



Description 163

Grant Recipient 163

Communication Strategy and Stakeholder Engagement 165

Report from the National Workshop on Safety and Quality in Pathology (2007) 165

Description 165

Grant Recipient 166

The Second National Workshop on Safety and Quality in Pathology (2008) 168



Description 168

Grant Recipient 168

Best Practice in Pathology Requesting and Reporting Workshop (2009) 169



Description 169

Grant Recipient 170

Pathology Workforce Workshop (2011) 171



Description 171

Grant Recipient 171

Areas for Future Consideration 174

Appendix A – Report Summaries Relevant to Different Themes 175






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