scholarly journals Cost, profitability and value of laboratory diagnostics: in God we trust, all others bring data

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Giuseppe Lippi ◽  
Mario Plebani
Keyword(s):  
Laboratory Tests ◽  
Clinical Pathways ◽  
Laboratory Medicine ◽  
Scale Economy ◽  
Therapeutic Monitoring ◽  
Laboratory Diagnostics ◽  
Clinical Value ◽  
Healthcare Budget ◽  
The Impact ◽  
Diagnostic Investigations

Abstract Although laboratory tests are the most used diagnostic investigations for screening, diagnosing, prognosticating and therapeutic monitoring of most human diseases, laboratory medicine is currently seen as many other economic industries by some policymakers and administrators, and is hence subjected to scale economy and assessed accordingly, despite the incremental clinical value that laboratory tests can generate. According to a genuine economic perspective, the impact of diagnostic testing on a healthcare budget is lower than 2.5%, whilst its profitability is over 100%, a net profit margin over 7-fold larger than whatever other human industry. Even more importantly, the impact of laboratory tests on clinical outcomes is now clear and virtually incontestable, as their use will improve clinical pathways much more than any other diagnostic investigations. The many ongoing attempts to downsize the importance of laboratory medicine as costs centers, or even the concept that public laboratory services can be safely eliminated or outsourced to external private professional organizations, shall hence be challenged. Laboratory medicine not only is vital to patient care and patient flow, and will remain so for many years to come, but is also a valuable economical resource for the healthcare facilities.

scholarly journals Cost, profitability and value of laboratory diagnostics: in God we trust, all others bring data

2019 ◽  
Vol 43 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Giuseppe Lippi ◽  
Mario Plebani
Keyword(s):  
Laboratory Tests ◽  
Clinical Pathways ◽  
Laboratory Medicine ◽  
Scale Economy ◽  
Therapeutic Monitoring ◽  
Laboratory Diagnostics ◽  
Clinical Value ◽  
Healthcare Budget ◽  
The Impact ◽  
Diagnostic Investigations

Abstract Although laboratory tests are the most used diagnostic investigations for screening, diagnosing, prognosticating and therapeutic monitoring of most human diseases, laboratory medicine is currently seen as many other economic industries by some policymakers and administrators, and is hence subjected to scale economy and assessed accordingly, despite the incremental clinical value that laboratory tests can generate. According to a genuine economic perspective, the impact of diagnostic testing on a healthcare budget is lower than 2.5%, whilst its profitability is over 100%, a net profit margin over 7-fold larger than whatever other human industry. Even more importantly, the impact of laboratory tests on clinical outcomes is now clear and virtually incontestable, as their use will improve clinical pathways much more than any other diagnostic investigations. The many ongoing attempts to downsize the importance of laboratory medicine as costs centers, or even the concept that public laboratory services can be safely eliminated or outsourced to external private professional organizations, shall hence be challenged. Laboratory medicine not only is vital to patient care and patient flow, and will remain so for many years to come, but is also a valuable economical resource for the healthcare facilities.

scholarly journals The role of evidence-based laboratory medicine in health service

2002 ◽  
Vol 21 (3) ◽  
pp. 245-254 ◽  
Author(s):  
Nada Majkic-Singh
Keyword(s):  
Health Care ◽  
Clinical Experience ◽  
Evidence Based Medicine ◽  
Laboratory Tests ◽  
Laboratory Medicine ◽  
Systematic Research ◽  
Evidence Based ◽  
External Evidence ◽  
Based Medicine ◽  
The Impact

Evidence-based laboratory medicine (EBLM) is the use of the current best evidence of the utility of laboratory tests in making decisions about the care of individual patients. This practice means integrating laboratory and clinical experience with the last available external evidence from systematic research. It means that the definition of EBLM focuses on two key elements: experience and evidence from systematic research. Although the term evidence-based medicine (EBM) was created in Canada at Mc Master University by a group lad by Dr Gard Guyatt, there are various claims as to the origin of its practice. Regardless of its origins, many factors have come together over the past 30 years to drive the movement to EBM. One factor is those individual physicians, faced with numerous medical informations; the second factor is the global phenomenon of increasing health care costs and third is that patients who have generally more education, want the best in diagnostics and therapies. It means that evidence-based medicine has been driven by the need to cape with information overload, by costcontrol, and by public impatient for the best in diagnostics and treatment. Clinical guidelines care maps, and outcome measures are quality improvement tools for the appropriateness, efficiency and effectiveness of health services. Laboratory professionals must direct more effort to demonstrating the impact of laboratory tests on a greater variety of clinical outcomes. Evidence-based laboratory medicine aims to advise clinical diagnosis and management of disease through systematic researching and disseminating generalisible new knowledge that meets the standard of critical review on clinically effective practice of laboratory investigations. In laboratory medicine, the use of tests increases; new tests are constantly introduced, but "old" tests are seldom removed from the repertoire. This, together with limited public funds for the health care should underline the challenge for laboratory professionals to provide evidence for the utility of different tests. This practice means integrating laboratory and clinical experience with the best available external evidence from systematic research therefore, it is important that advice given by laboratory medicine professionals are sound and based on evidence in the pre-analytical, analytical, and post-analytical phases of the diagnostic process. This paper provides an insight into the rationale, methodology and the phases of the EBLM.

scholarly journals Laboratory Diagnostics and Quality of Blood Collection / Laboratorijska Dijagnostika I Kvalitet Uzimanja Uzoraka Krvi

2015 ◽  
Vol 34 (3) ◽  
pp. 288-294 ◽  
Author(s):  
Gabriel Lima-Oliveira ◽  
Giuseppe Lippi ◽  
Gian Luca Salvagno ◽  
Geraldo Picheth ◽  
Gian Cesare Guidi
Keyword(s):  
Health Care Professionals ◽  
Venous Blood ◽  
Laboratory Medicine ◽  
Therapeutic Monitoring ◽  
Blood Collection ◽  
Laboratory Diagnostics ◽  
Medical Procedure ◽  
Analytical Phase ◽  
Medicine Analysis ◽  
Collection Practice

SummaryDiagnostic blood samples collected by phlebotomy are the most common type of biological specimens drawn and sent to laboratory medicine facilities for being analyzed, thus supporting caring physicians in patient diagnosis, follow-up and/or therapeutic monitoring. Phlebotomy, a relatively invasive medical procedure, is indeed critical for the downstream procedures accomplished either in the analytical phase made in the laboratory or in the interpretive process done by the physicians. Diagnosis, management, treatment of patients and ultimately patient safety itself can be compromised by poor phlebotomy quality. We have read with interest a recent article where the authors addressed important aspects of venous blood collection for laboratory medicine analysis. The authors conducted a phlebotomy survey based on the Clinical and Laboratory Standard Institute (CLSI) H03-A6 document (presently replaced by the GP41-A6 document) in three government hospitals in Ethiopia to evaluate 120 professionals (101 non-laboratory professionals vs. 19 laboratory professionals) as regards the venous blood collection practice. The aim of this mini (non-systematic) review is to both take a cue from the above article and from current practices we had already observed in other laboratory settings, and discuss four questionable activities performed by health care professionals during venous blood collection. We refer to: i) diet restriction assessment; ii) puncture site cleansing; iii) timing of tourniquet removal and; iv) mixing specimen with additives

scholarly journals Detection and documentation of DRG-relevant comorbidities using laboratory tests

2002 ◽  
Vol 25 (3) ◽  
pp. 152 ◽  
Author(s):  
Michael H Wilke ◽  
Mike Schenker ◽  
George Hoffmann
Keyword(s):  
Success Rate ◽  
Teaching Hospital ◽  
Laboratory Tests ◽  
Laboratory Medicine ◽  
Insurance Companies ◽  
Academic Teaching ◽  
Coding Strategies ◽  
Lower Severity ◽  
Academic Teaching Hospital ◽  
The Impact

Germany will soon begin per case payment by DRG, and preparations are in progress in most hospitals and insurance companies. The Academic Teaching Hospital Munich-Schwabing in Munich decided to explore coding strategies by considering the impact of diagnoses that could be detected by pathology An Australian database was analysed. We detected "discriminating'diagnoses - that is, diagnoses that could be found in level A or B DRGs, and not in the respective lower severity DRG. After isolating 584 diagnoses, they were rated by a laboratory specialist, to determine whether they could be proved by pathology tests. 187 diagnoses were selected in this way. In the next step, theoretical cases were generated and grouped. 157 diagnoses were found to produce a switch to a higher DRG. The diagnoses, the DRGs and the respective laboratory tests were then arranged in a small MS-Excel program to allow comfortable browsing. The overall success rate of 84% shows that laboratory medicine can contribute to correct coding for DRGs.

scholarly journals Laboratory medicine in modern teaching clinical physicians

2021 ◽  
Vol 26 ◽  
pp. 4385
Author(s):  
T. V. Vavilova ◽  
O. V. Sirotkina ◽  
N. Yu. Chernysh ◽  
V. S. Berestovskaya ◽  
Yu. I. Zhilenkova ◽  
...  
Keyword(s):  
High Performance ◽  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Practical Experience ◽  
Laboratory Medicine ◽  
High Tech ◽  
Laboratory Diagnostics ◽  
Evidence Based ◽  
Technological Breakthrough ◽  
Based Medicine

At the end of the last century and, especially, in the first two decades of the 21st century, a significant technological breakthrough took place in clinical laboratory diagnostics in Russia. The transition from manual techniques to high-tech and high-performance automated systems has changed the potential of laboratory medicine. The laboratory has become a high-tech, rapidly developing branch of medical organizations. Following the changes in technology, the range of diagnostic tests began to alter, while the list of laboratory tests available grew. These dynamics are growing every year. Simple routine techniques, practiced for all patients, are complemented by more specific tests. The place of conventional routine tests has been determined by many years of practical experience, while modern analyzers allow the use of tests with a high evidence value of recommendations, which, in the context of evidence-based medicine, enable the clinician to conduct a personalized diagnostic search. At the same time, in order to use all the possibilities of laboratory medicine, the discipline Clinical Laboratory Diagnostics should be included in educational programs at different stages of a doctor's training.

scholarly journals Leadership and Management in Clinical Biochemistry

2017 ◽  
Vol 36 (3) ◽  
pp. 216-219 ◽  
Author(s):  
Per E. Jørgensen
Keyword(s):  
Laboratory Tests ◽  
Elderly Population ◽  
Clinical Biochemistry ◽  
Clinical Pathways ◽  
Clinical Work ◽  
Laboratory Medicine ◽  
Population Increase ◽  
Leadership And Management ◽  
Active Involvement ◽  
Technological Developments

Summary Challenging times lay ahead for laboratory medicine in Europe due to at least three factors. 1) The scientific and technological developments increase the diagnostic possibilities but at the same time they will also change the interfaces among the different specialties of laboratory medicine. 2) The demographic changes with a more elderly population increase the demands for laboratory tests. 3) The increased complexity of the health care system combined with more well-informed patients calls for more coherent clinical pathways across the different sectors, for an increased focus on patient safety, and for a stronger involvement of patients and relatives. These issues cause both threats and opportunities for laboratory medicine – and they have to be handled in a situation with limited economic growth and shortage of money. This calls for a new organization of laboratory medicine in many hospitals as well as for a more active involvement of laboratory medicine in the clinical work and in the contact with the patients. Laboratory medicine will need dedicated and skillful leadership in order to prosper and grow during these challenging changes.

scholarly journals Standards of laboratory practice: cardiac drug monitoring

1998 ◽  
Vol 44 (5) ◽  
pp. 1096-1109 ◽  
Author(s):  
Roland Valdes ◽  
Saeed A Jortani ◽  
Mihai Gheorghiade
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Drug Monitoring ◽  
Free Fraction ◽  
Therapeutic Index ◽  
Therapeutic Monitoring ◽  
Therapeutic Drug ◽  
Laboratory Practice ◽  
Clinical Complications ◽  
The Impact

Abstract In this Standard of Laboratory Practice we recommend guidelines for therapeutic monitoring of cardiac drugs. Cardiac drugs are primarily used for treatment of angina, arrhythmias, and congestive heart failure. Digoxin, used in congestive heart failure, is widely prescribed and therapeutically monitored. Monitoring and use of antiarrhythmics such as disopyramide and lidocaine have been steadily declining. Immunoassay techniques are currently the most popular methods for measuring cardiac drugs. Several reasons make measurement of cardiac drugs in serum important: their narrow therapeutic index, similarity in clinical complications and presentation of under- and overmedicated patients, need for dosage adjustments, and confirmation of patient compliance. Monitoring may also be necessary in other circumstances, such as assessment of acetylator phenotypes. We present recommendations for measuring digoxin, quinidine, procainamide (and N-acetylprocainamide), lidocaine, and flecainide. We discuss guidelines for measuring unbound digoxin in the presence of an antidote (Fab fragments), for characterizing the impact of digoxin-like immunoreactive factor (DLIF) and other cross-reactants on immunoassays, and for monitoring the unbound (free fraction) of drugs that bind to α1-acid glycoprotein. We also discuss logistic, clinical, hospital, and laboratory practice guidelines needed for implementation of a successful therapeutic drug monitoring service for cardiac drugs.

Bridging the Gap With Choosing Wisely Recommendations: What Laboratory Topics Matter Most to Other Medical Specialty Societies?

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
Barbara Caldwell
Keyword(s):  
Women’S Health ◽  
Women's Health ◽  
Laboratory Tests ◽  
Pap Smear ◽  
Medical Specialty ◽  
Laboratory Medicine ◽  
Choosing Wisely ◽  
Topic Area ◽  
Medical Specialties ◽  
Smear Testing

Abstract Introduction This study sought to evaluate the nature and frequency of laboratory recommendations made by medical societies other than ASCP. Methods Review of all 2012 to 2018 ABIM Choosing Wisely (CW) non-ASCP laboratory recommendations and categorization of recommendations per topic area. Results There are 107 total recommendations made by other medical specialties that involve laboratory medicine. The most common recommendations are (1) Transfusion Medicine: to minimize transfusion of PRCs (19 recommendations, 18%); (2) Women’s Health: Pap smear testing, other women’s health testing (18 recommendations, 17%); and (3) General Laboratory: reducing repetitive routine laboratory tests (10 recommendations, 9%). Most (64, 60%) recommendations addressed screening while 29 (27%) focused on treatment and 14 (13%) were related to monitoring disease. Conclusion Almost one-half (44%) of all recommendations fell into three common areas and there were more recommendations related to screening for disease than for treatment or monitoring. For Choosing Wisely to achieve increasing success, increasing efforts are needed to disseminate this information, promote multidisciplinary effective test utilization, and encourage continued laboratory medicine recommendations from all medical stakeholders.

scholarly journals Current Evidence and Future Perspectives on the Effective Practice of Patient-Centered Laboratory Medicine

2015 ◽  
Vol 61 (4) ◽  
pp. 589-599 ◽  
Author(s):  
Mike J Hallworth ◽  
Paul L Epner ◽  
Christoph Ebert ◽  
Corinne R Fantz ◽  
Sherry A Faye ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Clinical Effectiveness ◽  
Laboratory Medicine ◽  
Current Evidence ◽  
Patient Centered ◽  
Definition Of ◽  
Current Utilization ◽  
Measures Of Effectiveness ◽  
The Impact ◽  
Primary Measure

AbstractBACKGROUNDSystematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.CONTENTThis review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care.SUMMARYTo maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

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