Background: A widely used test for glucose control is the hemoglobin A1c, which correlates with the patient’s mean blood glucose levels over the previous 2-3 months. To evaluate long-term glycemic control during an inpatient hospitalization, all insulin order sets in the electronic medical record (EMR) have a defaulted hemoglobin A1c order. However, this raised concerns of overtesting for hemoglobin A1c.
Methods: In June of 2013, logic changes were made to the insulin order sets to no longer default a hemoglobin A1c if the patient had a result already on file within the previous 60 days. To evaluate the impact of this change, we looked at a period of November 2011 through October 2016 for all inpatients with a diagnosis of diabetes; we then looked at patients who had both a hemoglobin A1c ordered within 2 days of admission, and an A1c result in the EMR within 2 months. We performed an interrupted time series analysis to measure the impact of these changes.
Results: We found that the order set intervention led to a decrease in the number of redundant hemoglobin A1c tests ordered from 30.0% of hospitalized diabetic patients to 14.7% (p < 0.0001). The slope of the trend line did not change significantly after the intervention. We estimate that approximately 909 unnecessary hemoglobin A1c tests were avoided per year, resulting in an annual savings of ~$12,000 per year.
Conclusions: The intervention of “undefaulting” the order for hemoglobin A1c for those patients with an existing result within 2 months has significantly reduced overutilization of this test. This approach to clinical decision support has the potential to be applied to other similar cases of overutilization of laboratory testing.
To cite this abstract:Varughese, JI; Clay, BJ; El-Kareh, R . HOW SWEET IT IS…REDUCING DUPLICATE HEMOGLOBIN A1C. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 224. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/how-sweet-it-is-reducing-duplicate-hemoglobin-a1c/. Accessed April 3, 2020.