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==Introduction== | ==Introduction== | ||
Establishing the correct diagnosis is fundamental to the appropriate treatment of patients, making [[laboratory]] [[Medical test|testing]] and other diagnostic services (e.g., radiology) critical to the overall practice of medicine. Some suggest that up to 70% of medical decisions are based, in part, on laboratory findings.<ref name="ForsmanWhy96">{{Cite journal |last=Forsman |first=R W |date=1996-05-01 |title=Why is the laboratory an afterthought for managed care organizations? |url=https://academic.oup.com/clinchem/article/42/5/813/5646564 |journal=Clinical Chemistry |language=en |volume=42 |issue=5 |pages=813–816 |doi=10.1093/clinchem/42.5.813 |issn=0009-9147}}</ref> While the specific percentage may be debatable, there is no question that laboratory diagnostics are central for medical practice today. The [[Coronavirus disease 2019|coronavirus disease 2019]] (COVID-19) pandemic highlighted the critical role that the nation's laboratories and laboratory professionals play in assuring quality healthcare, well beyond just the [[pandemic]] response. Healthcare leaders repeatedly acknowledged the importance of laboratory testing for COVID-19 patient management to, for example, assess symptomatic patients, identify emerging variants, and perform effective [[contact tracing]]. | Establishing the correct diagnosis is fundamental to the appropriate treatment of patients, making [[laboratory]] [[Medical test|testing]] and other diagnostic services (e.g., radiology) critical to the overall practice of medicine. Some suggest that up to 70% of medical decisions are based, in part, on laboratory findings.<ref name="ForsmanWhy96">{{Cite journal |last=Forsman |first=R W |date=1996-05-01 |title=Why is the laboratory an afterthought for managed care organizations? |url=https://academic.oup.com/clinchem/article/42/5/813/5646564 |journal=Clinical Chemistry |language=en |volume=42 |issue=5 |pages=813–816 |doi=10.1093/clinchem/42.5.813 |issn=0009-9147}}</ref> While the specific percentage may be debatable, there is no question that laboratory diagnostics are central for medical practice today. The [[Coronavirus disease 2019|coronavirus disease 2019]] (COVID-19) pandemic highlighted the critical role that the nation's laboratories and laboratory professionals play in assuring quality healthcare, well beyond just the [[pandemic]] response. Healthcare leaders repeatedly acknowledged the importance of laboratory testing for COVID-19 patient management to, for example, assess symptomatic patients, identify emerging variants, and perform effective [[contact tracing]].<ref name="CDCOver21">{{Cite web |last=Centers for Disease Control and Prevention |date=17 March 2021 |title=Overview of Testing for SARS-CoV-2 (COVID-19) |work=COVID-19 Portal |url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html |publisher=Centers for Disease Control and Prevention |accessdate=30 March 2021}}</ref> Laboratory medicine is also central to the worlds' [[public health]] response to COVID-19.<ref name="WHOLooking21">{{Cite web |last=World Health Organization |date=24 February 2021 |title=Looking back at a year that changed the world: WHO’s response to COVID-19 |url=https://www.who.int/publications/m/item/looking-back-at-a-year-that-changed-the-world-who-s-response-to-covid-19 |publisher=World Health Organization |accessdate=30 March 2021}}</ref> | ||
Laboratory testing is typically one of the highest volume medical activities in a health system.<ref name="CMSPhys20">{{Cite web |last=Centers for Medicare & Medicaid Services |date=03 December 2020 |title=Physician and Other Supplier Data CY 2018 |url=https://www.cms.gov/research-statistics-data-systems/medicare-provider-utilization-and-payment-data/medicare-provider-utilization-and-payment-data-physician-and-other-supplier/physician-and-other-supplier-data-cy-2018 |publisher=Centers for Medicare & Medicaid Services |accessdate=30 March 2021}}</ref> Despite their major role in driving clinical decision-making, laboratory diagnostics are highly variable and filled with opportunities to increase appropriate testing while reducing waste. Annual cost estimates in the U.S. for low-value screening, testing, or procedures range from $17.2 billion to $27.9 billion.<ref name="ShrankWaste19">{{Cite journal |last=Shrank |first=William H. |last2=Rogstad |first2=Teresa L. |last3=Parekh |first3=Natasha |date=2019-10-15 |title=Waste in the US Health Care System: Estimated Costs and Potential for Savings |url=https://jamanetwork.com/journals/jama/fullarticle/2752664 |journal=JAMA |language=en |volume=322 |issue=15 |pages=1501 |doi=10.1001/jama.2019.13978 |issn=0098-7484}}</ref> Excessive diagnostic testing can also increase patient risk while not improving diagnostic certainty.<ref name="BaloghImprov15">{{Cite book |last=Committee on Diagnostic Error in Health Care |last2=Board on Health Care Services |last3=Institute of Medicine |last4=The National Academies of Sciences, Engineering, and Medicine |date=2015-12-29 |editor-last=Balogh |editor-first=Erin P. |editor2-last=Miller |editor2-first=Bryan T. |editor3-last=Ball |editor3-first=John R. |title=Improving Diagnosis in Health Care |url=http://www.nap.edu/catalog/21794 |publisher=National Academies Press |place=Washington, D.C. |doi=10.17226/21794 |isbn=978-0-309-37769-0}}</ref> Achieving the aims of higher [[Quality (business)|quality]] and lower cost depends on the laboratory community taking a central role in improving effective test utilization. | |||
Over the last century, pathologists and laboratory professionals honed their craft while simultaneously expanding tools available to screen, diagnose, treat, and manage patients. The laboratorian historically focused quality efforts on a test's analytic quality. While analytic quality is necessary for appropriate care, it is not sufficient; effective test utilization requires clear medical justification to support the need for a particular test with an understanding of how the results will contribute to guiding patient management. This discussion focuses on the evolution of effective test utilization and implementation of laboratory stewardship as a laboratory leadership strategy to assure effective test use. | |||
==Evolution of quality in laboratory medicine== | |||
The pursuit of laboratory medicine quality improvement will shortly celebrate its one-hundredth anniversary. In 1922, a group of 39 physicians came together to form what is now known as the [[American Society for Clinical Pathology]] (ASCP), now the largest professional organization of pathologists and laboratory professionals in the world.<ref name="RodriguezTheAmer07">{{Cite journal |last=Rodriguez |first=Fred H. |last2=Ball |first2=John R. |date=2007-10 |title=The American Society for Clinical Pathology: The Pathology Society of “Firsts” |url=https://academic.oup.com/labmed/article-lookup/doi/10.1309/RTKE4EKQ61HMN37U |journal=Laboratory Medicine |language=en |volume=38 |issue=10 |pages=595–601 |doi=10.1309/RTKE4EKQ61HMN37U |issn=0007-5027}}</ref> The goal of the ASCP was to “achieve greater scientific proficiency in [[clinical pathology]] [meaning here the practice of pathology in the clinical setting, including both [[Anatomical pathology|anatomical]] and clinical pathology], and to maintain the status of clinical pathologists on an equal plane with other specialists.”<ref name="RodriguezTheAmer07" /> ASCP recognized the contributions and importance of both quality people and quality processes to assuring reliable laboratory results. As such, ASCP was instrumental in creating the American Board of Pathology (1935) to certify pathologists and the Board of Registry (now the Board of Certification) to certify laboratory professionals (1928).<ref name="RodriguezTheAmer07" /> ASCP, under the guidance of past president F. William Sunderman, created an inter-laboratory [[quality control]] program, now recognized as the College of American Pathologists’ Proficiency Testing Program.<ref name="LundbergThePath03">{{Cite web |last=Lundberg |first=G.D. |date=27 June 2003 |title=The Pathologist of the Century -- F. William Sunderman, MD, PhD, ScD |work=Medscape |url=https://www.medscape.com/viewarticle/457676 |publisher=WebMD, LLC |accessdate=05 April 2021}}</ref><ref name="BelkASurv47">{{Cite journal |last=Belk |first=William P. |last2=Sunderman |first2=F. William |date=1947-11-01 |title=A Survey of the Accuracy of Chemical Analyses in Clinical Laboratories |url=https://academic.oup.com/ajcp/article-lookup/doi/10.1093/ajcp/17.11.853 |journal=American Journal of Clinical Pathology |language=en |volume=17 |issue=11 |pages=853–861 |doi=10.1093/ajcp/17.11.853 |issn=0002-9173}}</ref> | |||
Revision as of 15:40, 5 August 2021
| Full article title | Strategies for laboratory professionals to drive laboratory stewardship |
|---|---|
| Journal | Practical Laboratory Medicine |
| Author(s) | White, Terra, E.; Wong, Wesley B.; Janowiak, Diane; Hilborne, Lee H. |
| Author affiliation(s) | Quest Diagnostics, hc1, University of California - Los Angeles |
| Primary contact | terra dot e dot white at questdiagnostics dot com |
| Year published | 2021 |
| Volume and issue | 26 |
| Article # | e00249 |
| DOI | 10.1016/j.plabm.2021.e00249 |
| ISSN | 2352-5517 |
| Distribution license | Creative Commons Attribution 4.0 International |
| Website | https://www.sciencedirect.com/science/article/pii/S2352551721000494 |
| Download | https://www.sciencedirect.com/science/article/pii/S2352551721000494/pdfft (PDF) |
 |
This article should be considered a work in progress and incomplete. Consider this article incomplete until this notice is removed. |
Abstract
Appropriate laboratory testing is critical in today's healthcare environment that aims to improve patient care while reducing cost. In recent years, laboratory stewardship has emerged as a strategy for assuring quality in laboratory medicine with the goal of providing the right test for the right patient at the right time. Implementing a laboratory stewardship program now presents a valuable opportunity for laboratory professionals to exercise leadership within health systems and to drive change toward realizing aims in healthcare. The proposed framework for program implementation includes five key elements: 1) a clear vision and organizational alignment; 2) appropriate skills for program execution and management; 3) resources to support the program; 4) incentives to motivate participation; and, 5) a plan of action that articulates program objectives and metrics. This framework builds upon principles of change management, with emphasis on engagement with clinical and administrative stakeholders and the use of clinical data as the basis for change. These strategies enable laboratory professionals to cultivate organizational support for improving laboratory use and take a leading role in providing high-quality patient care.
Keywords: clinical laboratory, laboratory stewardship, quality of health care, change management, patient care, leadership
Introduction
Establishing the correct diagnosis is fundamental to the appropriate treatment of patients, making laboratory testing and other diagnostic services (e.g., radiology) critical to the overall practice of medicine. Some suggest that up to 70% of medical decisions are based, in part, on laboratory findings.[1] While the specific percentage may be debatable, there is no question that laboratory diagnostics are central for medical practice today. The coronavirus disease 2019 (COVID-19) pandemic highlighted the critical role that the nation's laboratories and laboratory professionals play in assuring quality healthcare, well beyond just the pandemic response. Healthcare leaders repeatedly acknowledged the importance of laboratory testing for COVID-19 patient management to, for example, assess symptomatic patients, identify emerging variants, and perform effective contact tracing.[2] Laboratory medicine is also central to the worlds' public health response to COVID-19.[3]
Laboratory testing is typically one of the highest volume medical activities in a health system.[4] Despite their major role in driving clinical decision-making, laboratory diagnostics are highly variable and filled with opportunities to increase appropriate testing while reducing waste. Annual cost estimates in the U.S. for low-value screening, testing, or procedures range from $17.2 billion to $27.9 billion.[5] Excessive diagnostic testing can also increase patient risk while not improving diagnostic certainty.[6] Achieving the aims of higher quality and lower cost depends on the laboratory community taking a central role in improving effective test utilization.
Over the last century, pathologists and laboratory professionals honed their craft while simultaneously expanding tools available to screen, diagnose, treat, and manage patients. The laboratorian historically focused quality efforts on a test's analytic quality. While analytic quality is necessary for appropriate care, it is not sufficient; effective test utilization requires clear medical justification to support the need for a particular test with an understanding of how the results will contribute to guiding patient management. This discussion focuses on the evolution of effective test utilization and implementation of laboratory stewardship as a laboratory leadership strategy to assure effective test use.
Evolution of quality in laboratory medicine
The pursuit of laboratory medicine quality improvement will shortly celebrate its one-hundredth anniversary. In 1922, a group of 39 physicians came together to form what is now known as the American Society for Clinical Pathology (ASCP), now the largest professional organization of pathologists and laboratory professionals in the world.[7] The goal of the ASCP was to “achieve greater scientific proficiency in clinical pathology [meaning here the practice of pathology in the clinical setting, including both anatomical and clinical pathology], and to maintain the status of clinical pathologists on an equal plane with other specialists.”[7] ASCP recognized the contributions and importance of both quality people and quality processes to assuring reliable laboratory results. As such, ASCP was instrumental in creating the American Board of Pathology (1935) to certify pathologists and the Board of Registry (now the Board of Certification) to certify laboratory professionals (1928).[7] ASCP, under the guidance of past president F. William Sunderman, created an inter-laboratory quality control program, now recognized as the College of American Pathologists’ Proficiency Testing Program.[8][9]
References
- ↑ Forsman, R W (1 May 1996). "Why is the laboratory an afterthought for managed care organizations?" (in en). Clinical Chemistry 42 (5): 813–816. doi:10.1093/clinchem/42.5.813. ISSN 0009-9147. https://academic.oup.com/clinchem/article/42/5/813/5646564.
- ↑ Centers for Disease Control and Prevention (17 March 2021). "Overview of Testing for SARS-CoV-2 (COVID-19)". COVID-19 Portal. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html. Retrieved 30 March 2021.
- ↑ World Health Organization (24 February 2021). "Looking back at a year that changed the world: WHO’s response to COVID-19". World Health Organization. https://www.who.int/publications/m/item/looking-back-at-a-year-that-changed-the-world-who-s-response-to-covid-19. Retrieved 30 March 2021.
- ↑ Centers for Medicare & Medicaid Services (3 December 2020). "Physician and Other Supplier Data CY 2018". Centers for Medicare & Medicaid Services. https://www.cms.gov/research-statistics-data-systems/medicare-provider-utilization-and-payment-data/medicare-provider-utilization-and-payment-data-physician-and-other-supplier/physician-and-other-supplier-data-cy-2018. Retrieved 30 March 2021.
- ↑ Shrank, William H.; Rogstad, Teresa L.; Parekh, Natasha (15 October 2019). "Waste in the US Health Care System: Estimated Costs and Potential for Savings" (in en). JAMA 322 (15): 1501. doi:10.1001/jama.2019.13978. ISSN 0098-7484. https://jamanetwork.com/journals/jama/fullarticle/2752664.
- ↑ Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine (29 December 2015). Balogh, Erin P.; Miller, Bryan T.; Ball, John R.. eds. Improving Diagnosis in Health Care. Washington, D.C.: National Academies Press. doi:10.17226/21794. ISBN 978-0-309-37769-0. http://www.nap.edu/catalog/21794.
- ↑ 7.0 7.1 7.2 Rodriguez, Fred H.; Ball, John R. (1 October 2007). "The American Society for Clinical Pathology: The Pathology Society of “Firsts”" (in en). Laboratory Medicine 38 (10): 595–601. doi:10.1309/RTKE4EKQ61HMN37U. ISSN 0007-5027. https://academic.oup.com/labmed/article-lookup/doi/10.1309/RTKE4EKQ61HMN37U.
- ↑ Lundberg, G.D. (27 June 2003). "The Pathologist of the Century -- F. William Sunderman, MD, PhD, ScD". Medscape. WebMD, LLC. https://www.medscape.com/viewarticle/457676. Retrieved 05 April 2021.
- ↑ Belk, William P.; Sunderman, F. William (1 November 1947). "A Survey of the Accuracy of Chemical Analyses in Clinical Laboratories" (in en). American Journal of Clinical Pathology 17 (11): 853–861. doi:10.1093/ajcp/17.11.853. ISSN 0002-9173. https://academic.oup.com/ajcp/article-lookup/doi/10.1093/ajcp/17.11.853.
Notes
This presentation is faithful to the original, with only a few minor changes to presentation, grammar, and punctuation. In some cases important information was missing from the references, and that information was added.
