Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions

Abstract

Diagnostics services are an essential component of healthcare systems, advancing universal health coverage and ensuring global health security, but are often unavailable or under-resourced in low- and middle-income (LMIC) countries. Typically, diagnostics are delivered at various tiers of the laboratory network based on population needs, and resource and infrastructure constraints. A diagnostic network additionally incorporates screening and includes point-of-care testing that may occur outside of a laboratory in the community and clinic settings; it also emphasizes the importance of supportive network elements, including specimen referral systems, as being critical for the functioning of the diagnostic network. To date, design and planning of diagnostic networks in LMICs has largely been driven by infectious diseases such as TB and HIV, relying on manual methods and expert consensus, with a limited application of data analytics. Recently, there have been efforts to improve diagnostic network planning, including diagnostic network optimization (DNO). The DNO process involves the collection, mapping, and spatial analysis of baseline data; selection and development of scenarios to model and optimize; and lastly, implementing changes and measuring impact. This review outlines the goals of DNO and steps in the process, and provides clarity on commonly used terms.

Use of Physical Accessibility Modelling in Diagnostic Network Optimization: A Review

“…This may impact on the realism of the model results and is at odds with the growing literature that uses this type of modeling approach for various other health services [ 10 , 40 , 41 , 42 ]. This seemingly sub-optimal use of the recent physical accessibility models may come from the recent consideration of the importance of data analytics in DNO [ 6 ]. It may also reflect a decoupling of the types of geospatial tools traditionally used for optimizing supply chains (of diagnostics in this case but it originates from the commercial sector), with the category of tools that inform health systems strengthening and scaling up.…”

“…Diagnostic networks encompass all the components, considering not only tests performed within laboratories, but also those conducted by devices located in communities or clinics, outside the laboratory setting, as well as the specimen referral system, which links referral and reference sites [ 6 ]. Initially based on manual methods and expert consensus, the design and planning of diagnostic networks has recently moved towards a greater use of advanced digital tools and data analytics, notably using models link to Geographic Information Systems (GIS), targeting “diagnostic network optimization” (DNO, see [ 6 ] and references therein). DNO usually implies mathematically solving the best combination of variables to optimize outputs such as costs, capacity, turnaround time of results and device placements.…”

“…The ultimate goal of DNO is usually to maximize accessibility to testing centers for the population, while minimizing overall costs, subject to country-specific constraints and assumptions applied. [ 6 , 7 , 8 ].…”

Implementation considerations for the WHO Essential Diagnostics List with insights from the Essential Medicines List: A scoping review protocol

“…It is well acknowledged that diagnostic tests contribute significantly to delivery of quality healthcare, and it makes up 5% of a hospital's budget but leverage 60-70% of all critical decision-making such as admittance, discharge, and medication 1 . As a consequence there is provision of objective information that enables patients to be diagnosed, treated and/or monitored precisely and swiftly 1,4,5 . Diagnostic tests further aid in recognizing complications such as drug resistance, enhances epidemiological surveillance for early disease detection and monitoring, as well as research and development [3][4][5] .…”

“…As a consequence there is provision of objective information that enables patients to be diagnosed, treated and/or monitored precisely and swiftly 1,4,5 . Diagnostic tests further aid in recognizing complications such as drug resistance, enhances epidemiological surveillance for early disease detection and monitoring, as well as research and development [3][4][5] .…”