Identifying Preanalytic and Postanalytic Laboratory Quality Gaps Using a Data Warehouse and Structured Multidisciplinary Process
| Autor: | Laura K. Bechtel, Andrew T. Sterrett, David H. Smith, Marsha A. Raebel, Emily B. Schroeder, LeeAnn M. Quintana, Ira M. Lubin, Lisa E. Pieper, Joseph A. Chorny, Paul L. Epner, Susan M. Shetterly |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Laboratory Proficiency Testing Process management Quality management Quality Assurance Health Care Computer science Process (engineering) media_common.quotation_subject Article Pathology and Forensic Medicine 03 medical and health sciences 0302 clinical medicine Data Warehousing Multidisciplinary approach Humans Quality (business) media_common business.industry General Medicine Data warehouse Medical Laboratory Technology 030104 developmental biology 030220 oncology & carcinogenesis Laboratories business Quality assurance |
| Zdroj: | Archives of Pathology & Laboratory Medicine. 143:518-524 |
| ISSN: | 1543-2165 0003-9985 |
| DOI: | 10.5858/arpa.2018-0093-oa |
| Popis: | Context.— The laboratory total testing process includes preanalytic, analytic, and postanalytic phases, but most laboratory quality improvement efforts address the analytic phase. Expanding quality improvement to preanalytic and postanalytic phases via use of medical data warehouses, repositories that include clinical, utilization, and administrative data, can improve patient care by ensuring appropriate test utilization. Cross-department, multidisciplinary collaboration to address gaps and improve patient and system outcomes is beneficial. Objective.— To demonstrate medical data warehouse utility for characterizing laboratory-associated quality gaps amenable to preanalytic or postanalytic interventions. Design.— A multidisciplinary team identified quality gaps. Medical data warehouse data were queried to characterize gaps. Organizational leaders were interviewed about quality improvement priorities. A decision aid with elements including national guidelines, local and national importance, and measurable outcomes was completed for each gap. Results.— Gaps identified included (1) test ordering; (2) diagnosis, detection, and documentation, and (3) high-risk medication monitoring. After examination of medical data warehouse data including enrollment, diagnoses, laboratory, pharmacy, and procedures for baseline performance, high-risk medication monitoring was selected, specifically alanine aminotransferase, aspartate aminotransferase, complete blood count, and creatinine testing among patients receiving disease-modifying antirheumatic drugs. The test utilization gap was in monitoring timeliness (eg, >60% of patients had a monitoring gap exceeding the guideline recommended frequency). Other contributors to selecting this gap were organizational enthusiasm, regulatory labeling, and feasibility of a significant laboratory role in addressing the gap. Conclusions.— A multidisciplinary process facilitated identification and selection of a laboratory medicine quality gap. Medical data warehouse data were instrumental in characterizing gaps. |
| Databáze: | OpenAIRE |
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