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™)
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.
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.
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.
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