1. Translational and Personalized Medicine Initiative: Quality of Care Project Report Project PI: Stephen Raab, MD

2. Development of a Laboratory Utilization Program to Improve Patient Care- Summary Background: Poor laboratory test utilization practices are a longstanding and widespread problem for laboratories. Poor utilization results in low quality care by negatively impacting: clinical effectiveness, patient safety, efficiency, timeliness, as well as cost Methodology: Pre- and post-intervention retrospective review of test utilization volumes for 3 test bundles that are currently over-utilized at Eastern Health. Lean-based intervention is front line (physician) root cause analysis and problem solving using case and control groups Expected outcome(s): 80% decrease in test utilization over post-intervention year. TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

3. Development of a Laboratory Utilization Program to Improve Patient Care - Milestones Previous reporting period milestones (completed): 1. Ethics approval obtained 2. Identification of 3 over-utilized test bundles for study (creatinine/BUN; LDH/CK/troponin; iron studies (CBC/iron/ferritin/transferrin) 3. Receipt of de-identified pre-intervention utilization data for 6 or 12 month periods from Eastern Health biochemistry laboratory (Data Steward: Ed Randell PhD) 4. Initial analysis of pre-intervention data in collaboration with IBM (Randy Giffen) and CHIA TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

4. Development of a Laboratory Utilization Program to Improve Patient Care- Achievements Objectives Achieved During the Reporting Period 1.Pre-intervention analysis completed for 3 test bundles 2.Hypotheses generated regarding reasons for over-utilization 3.Utilization data descriptive chart information generated for each test bundle to use during front line provider root cause analysis 4.Physician study (case) groups randomly selected from top 40 over- utilizers for each test bundle 5.Invitation letters for project participation being sent to study groups TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

5. Development of a Laboratory Utilization Program to Improve Patient Care-– Figures and Data Visualisation TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

6. Development of a Laboratory Utilization Program to Improve Patient Care-– Figures and Data Visualisation TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

7. Development of a Laboratory Utilization Program to Improve Patient Care-– Figures and Data Visualisation TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

8. Development of a Laboratory Utilization Program to Improve Patient Care-– Figures and Data Visualisation TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

9. Development of a Laboratory Utilization Program to Improve Patient Care- Challenges Challenges Faced During the Reporting Period  Potentially recruiting participants, as most of them are general practitioners outside of the city TPMI QoC Quarterly Report Project PI: Stephen Raab, MD

10. Development of a Laboratory Utilization Program to Improve Patient Care-– Next Objectives Aims for the Next Reporting Period 1.Aim to recruit 10 study physicians for each test bundle 2.Perform root cause analysis sessions with first 10 physicians 3.Plan adjustments to root cause analysis sessions based on initial 10 experiences TPMI QoC Quarterly Report Project PI: Stephen Raab, MD