Laboratory Medicine Quality Improvement
Evidence-based Laboratory Medicine (EBLM): Quality/Performance Measure Evaluation
Laboratory
Medicine Best Practices (LMBP™) Initiative: Systematic Evidence Review
and Evaluation Methods for Quality Improvement
Clinical Laboratory Integration into Healthcare Collaborative (CLIHC™)
http://www.cdc.gov/osels/lspppo/Laboratory_Medicine_Quality_Improvement/index.html
Evidence-based Laboratory Medicine (EBLM): Quality/Performance Measure Evaluation
The purpose of this program is to systematically identify,
develop, and pilot test laboratory medicine evidence-based
quality/performance measures to improve public health with measureable
laboratory practices which are safe, timely, efficient, effective,
equitable and patient-centered. Five cooperative agreements within
diverse healthcare settings, patient populations, and diagnostic
applications have encompassed the broad applicability of these
measures. Performance metrics related to common errors in pre-test and
post-test processes have been defined 
[PDF 430.51KB] and evidence-based improvements in laboratory test utilization have been proposed or implemented [PDF 526.87KB]
.
Laboratory medicine quality improvement research supports
healthcare reform goals to improve healthcare quality and safety. These
evidence-based practices have the potential to reduce overuse and
misuse of laboratory testing and increase the effective use of
laboratory services for better patient outcomes.
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Laboratory
Medicine Best Practices (LMBP™) Initiative: Systematic Evidence
Review and Evaluation Methods for Quality Improvement
Goals of the LMBP™ Initiative are to:
Establish and use systematic review methods to evaluate
evidence of laboratory practice effectiveness, especially in the
pre-and post-analytic phases
Improve healthcare quality and patient outcomes through
dissemination of evidence reviews of effectiveness which identify
evidence-based laboratory medicine “best practices”
Increase participation of laboratory professionals in quality improvement research and data collection
The LMBP™ systematic review and evaluation methods are
used to conduct reviews of practice effectiveness for pre- and
post-analytic laboratory quality improvement practices. This validated
six-step model, called "A-6" was published in 2011 (Laboratory Medicine Best Practices: Systematic Evidence Review and Evaluation Methods for Quality Improvement).
Subsequently, four evidence-based recommendations for quality
laboratory practices have been developed through the use of the A6
method and published in a peer-reviewed journal (https://www.futurelabmedicine.org/our_findings/)
For more information about the Laboratory
Medicine Best Practices initiative and opportunities for individual or
organization participation, please visit www.futurelabmedicine.org
On this site you may elect to:
Receive notifications of systematic review topics and findings
Submit suggestions for new systematic reviews that the LMBP™ staff should consider
Share information on your quality improvement projects
Access A6 method tutorials (no charge) and earn continuing education credits.
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Clinical Laboratory Integration into Healthcare Collaborative
(CLIHC™)
The Centers for Disease Control and Prevention (CDC)
convened seven Institutes from 1984 to 2007 on critical issues in
clinical laboratory practice. These institutes brought together
national and international experts to consider the role(s) of the
clinical laboratory in providing quality testing services for improved
patient outcomes. The Clinical Laboratory Integration into Healthcare
Collaborative (CLIHC™) was subsequently established by CDC’s Division of
Laboratory Science and Standards (DLSS) to study important “gaps”
identified in the institutes and to develop solutions to optimize the
effective use of laboratory services for better patient care.
Impact on Patient Care
CLIHCTM’s current focus explores the challenges
clinicians face for appropriate laboratory test selection and result
interpretation. Solutions for these challenges will improve
utilization of laboratory services and a reduce diagnostic and
treatment errors and delays.
CLIHCTM’s Projects
The 2012 CLIHCTM national survey of 1700 internal and family
medicine physicians revealed numerous challenges in laboratory service
utilization.
Test selection challenges included:
multiple or confusing test names for the same test
diverse testing panels with the same name
differing practice guidelines
communicating with laboratory professionals
Challenges in result interpretation identified in the survey included:
variation in laboratory normal values and reporting format
previous results not readily available
lack of timely reporting
results inconsistent with patient’s symptoms
Suggested solutions included:
CPOE with electronic suggestions for appropriate test ordering
clinical algorithms/pathways to guide test selection
interpretive comments
reflex testing
Communication with laboratory professionals is of
particular concern because it was the least frequent among the various
ordering and interpretation tactics used in dealing with the
challenges. However, when clinicians did consult with laboratory
professionals, the majority found it useful. Overuse, underuse, and
misuse of laboratory tests may be reduced and patient care improved, if
the methods deemed “useful” by the survey respondents can be available
to more physicians.
CLIHCTM’s projects concentrate on several approaches to support healthcare providers with appropriate laboratory test usage:
Development of smartphone/smartpad applications to guide clinicians step-by-step in appropriate coagulation testing
PTT Advisor
app launched in the iTunes store in 2012 guides clinicians in
appropriate follow-up testing for patients presenting with a normal
prothrombin test (PT) and abnormal partial thromboplastin time (PTT)
Development
of clinical decision support (CDS) mechanisms to help clinicians
select the appropriate laboratory test(s) and result interpretation(s)
for patient diagnoses. These may include mechanisms such as
algorithms, electronic test ordering guidance embedded in the computer
physician order entry (CPOE) system or the electronic health record
(EHR), and laboratory call centers.
Convening Communities of Practice (CoPs) for building
models of successful practices to improve communication between
clinicians and laboratory professionals and education to improve
clinical laboratory utilization
Survey of US medical schools’ laboratory medicine curriculum
Publications, Presentations, and Products
In 2012, two peer-reviewed publications from CLIHCTM raised awareness about gaps and potential aids for clinicians’ optimal utilization of clinical laboratory services.
Oxana Tcherniantchouk, Michael Laposata, and Marisa B. Marques. The isolated prolonged PTT. American Journal of Hematology. 2012; 88 (1): 82-85.
Passiment
E, Meisel J, Fontanesi J, Fritsma G, Aleryani S, Marques M. Decoding
laboratory test names: a major challenge to appropriate patient care. J
Gen Intern Med. 2013;28(3):453-458.
Three 2012 Newsletter Reports referenced CLIHCTM work
Society to Improve Diagnosis in Medicine, March 18 – highlighted Nomenclature article
Clinical Laboratory News, September – feature story about CLIHCTM
Dark Report, October 8 – highlighted the clinicians’ survey [PDF 2MB]
Journal of General Internal Medicine article cited on the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network (PSNet)
Recent CLIHCTM presentations given at conferences/meetings:
American Society of Clinical Pathology (ASCP) [PDF 2.03MB]
American Association of Clinical Chemistry (AACC) [PDF 4.3MB]
COLA [PDF 1.9MB]
Clinical Laboratory Improvement Advisory Committee (CLIAC) [PDF 264KB]
PTT Advisor app launched in iTunes, June 2012
http://www.cdc.gov/osels/lspppo/Laboratory_Medicine_Quality_Improvement/index.html