Background

Despite the importance of pathology testing in diagnosis and disease monitoring, there is little in-depth research about pathology test ordering in general practice and how it impacts patient outcomes. This is in part due to the limited availability of high-quality data. With the now-widespread use of electronic software in general practice comes the potential for electronic patient data to be used for research leading to better understanding of general practice activities, including pathology testing.

Objectives

This study aimed to examine the usefulness of electronic general practice pathology data to: (1) identify patients’ characteristics, (2) monitor quality of care, (3) evaluate intervention effects, (4) identify variations in patient care, and (5) measure patient outcomes. An exemplar study evaluating kidney function testing in type 2 diabetes mellitus (type 2 diabetes) compared to guidelines was used to demonstrate the value of pathology data.

Materials and methods

De-identified electronic data from approximately 200 general practices in Victoria were extracted using Outcome Health’s Population Level Analysis & Reporting (POLAR) Aurora research platform. Our study population included patients ≥18 diagnosed with type 2 diabetes before July 2016. Data from July 2016 to June 2018 were used to i) determine frequency of kidney function tests (KFT), and ii) identify whether antihypertensive medications were prescribed for abnormal KFT results.

Results

There were 20,514 active patients with type 2 diabetes identified from the data. The age and gender standardised estimate of diabetes prevalence was 4.9%, consistent with Australian estimates (5.2%). Sociodemographic features of prevalence, including higher prevalence in older males, were also consistent with previous Australian estimates.

Kidney function testing was performed annually, as recommended by guidelines, in 75.7% of patients, with higher annual testing observed in patients managed under general practice incentive programs (80.1%) than those who were not (72.2%). Antihypertensive medications were prescribed as recommended in 77.4% of patients with suspected microalbuminuria or macroalbuminuria based on KFT results.

Discussion

Evaluations using data from diabetes patients in this study illustrate the value of electronic data for identifying patients with the condition of interest (e.g. type 2 diabetes) along with sociodemographic characteristics. This allows for the ability to undertake analyses on pathology testing factors and the identification of variation compared to guidelines, which has a potential to ensure quality of care. Its potential to identify associations with incentive programs further demonstrates the advantages of the data’s longitudinal nature. These include the ability to assess temporal order and time interval of tests as a marker of quality of monitoring and evaluate intervention effects on a cohort over time. Finally, analyses on antihypertensive medication prescribing in patients with suspected micro/macroalbuminuria exemplified the electronic data’s usefulness in monitoring patient outcomes, such as appropriate prescribing based on pathology test results.

Conclusions

Electronic general practice data is an important resource which can provide valuable insights about the quality use of pathology. There are clear benefits to patients for better monitoring, and consequent better outcomes, and to inform policymakers about the best ways to channel resources to enhance the quality of care.

中文翻译：

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利用澳大利亚电子全科医学病理数据的潜力：对2型糖尿病患者病理学质量使用的检查。

背景

尽管病理学测试在诊断和疾病监测中非常重要，但很少有关于常规实践中的病理学测试顺序及其如何影响患者预后的深入研究。部分原因是高质量数据的可用性有限。如今，随着电子软件在全科医学中的广泛使用，电子患者数据被用于研究的潜力使人们能够更好地理解包括病理学测试在内的全科医学活动。

目标

这项研究旨在检查电子全科病理数据对以下方面的有用性：（1）识别患者的特征，（2）监控护理质量，（3）评估干预效果，（4）识别患者护理的差异，以及（5 ）衡量患者的预后。与指南相比，评估2型糖尿病（2型糖尿病）肾功能测试的一项示例性研究用于证明病理数据的价值。

材料和方法

使用结果健康组织的人口水平分析和报告（POLAR）Aurora研究平台，提取了维多利亚州大约200种常规做法中已取消标识的电子数据。我们的研究人群包括2016年7月之前诊断为18岁以上的2型糖尿病患者。2016年7月至2018年6月的数据用于：i）确定肾功能检查（KFT）的频率，以及ii）确定是否为异常KFT开了抗高血压药结果。

结果

从数据中识别出20,514名活跃的2型糖尿病患者。糖尿病流行的年龄和性别标准化评估为4.9％，与澳大利亚的评估结果一致（5.2％）。患病率的社会人口统计学特征，包括老年男性患病率较高，也与澳大利亚先前的估计相符。

按照指南的建议，每年对肾功能检查的患者为75.7％，在全科医生激励计划管理的患者中观察到的年度检查（80.1％）比未接受肾病检查的患者（72.2％）高。根据KFT结果，在怀疑有微量白蛋白尿或大白蛋白尿的77.4％的患者中，建议按照推荐的方式使用降压药。

讨论区

在这项研究中，使用来自糖尿病患者的数据进行的评估表明，电子数据可用于识别患有目标疾病（例如2型糖尿病）的患者以及社会人口统计学特征。与指南相比，可以进行病理学测试因素分析和变异鉴定，从而有可能确保护理质量。它有可能确定与奖励计划的关联，这进一步证明了数据纵向性质的优势。其中包括评估测试的时间顺序和时间间隔的能力，以作为监测质量的标志，并评估随时间推移对队列的干预效果。最后，

结论

电子全科医学数据是重要的资源，可以提供有关病理学质量使用的有价值的见解。显然，对患者进行更好的监控，从而带来更好的结果，并告知政策制定者有关最佳途径来分配资源以提高护理质量具有明显的好处。