Clinical laboratory services for primary healthcare centers in urban cities: a pilot ACO model of ten primary healthcare centers

Abstract

Background Primary healthcare centers (PHC) ensure that patients receive comprehensive care from promotion and prevention to treatment, rehabilitation, and palliative care in a familiar environment. It is designed to provide first-contact, continuous, comprehensive, and coordinated patient care that will help achieve equity in the specialty healthcare system. The healthcare in Saudi Arabia is undergoing transformation to Accountable Care Organizations (ACO) model. In order for the Kingdom of Saudi Arabia (KSA) to achieve its transformational goals in healthcare, the improvement of PHCs’ quality and utilization is crucial. An integral part of this service is the laboratory services. Methods This paper presents a pilot model for the laboratory services of PHC's in urban cities. The method was based on the FOCUS-PDCA quality improvement method focusing on the pre-analytical phase of the laboratory testing as well as the Saudi Central Board for Accreditation of Healthcare Institutes (CBAHI) gap analysis and readiness within the ten piloted primary healthcare centers. Results The Gap analysis, revealed in-consistency in the practice, lead to lower the quality of the service, which was seen in the low performance of the chosen key performance indicators (KPI's) (high rejection rates, lower turn-around times (TAT) for test results) and also in the competency of the staff. Following executing the interventions, and by using some of the ACO Laboratory strategies; the KPI rates were improved, and our results exceeded the targets that we have set to reach during the first year. Also introducing the electronic connectivity improved the TAT KPI and made many of the processes leaner. Conclusions Our results revealed that the centralization of PHC's laboratory service to an accredited reference laboratory and implementing the national accreditation standards improved the testing process and lowered the cost, for the mass majority of the routine laboratory testing. Moreover, the model shed the light on how crucial the pre-analytical phase for laboratory quality improvement process, its effect on cost reduction, and the importance of staff competency and utilization.

Patients and Health Professionals’ Perceptions of Primary Health Care Services in Saudi Arabia: A Scoping Review

“…The health professionals' perceptions were assessed in terms of the quality of various aspects of the PHC services, burnout, and job satisfaction. In terms of the health professionals' perceptions of some aspects of PHC services, several studies examined their perceptions of the use of electronic health records (EHRs), 14,15,23 safety culture, 36,38 communicable disease management, 29 emergency services, 30 laboratory services, 26 and how cost-effective are the specialized reference clinics. 22 Electronic health records (EHR) are vital for the delivery of high-quality health care.…”

“…A study found that the implementation of accreditation standards and the provision of laboratory service at a centered laboratory lowered the cost and improved the testing process for most of the routine laboratory tests. 26 The role of primary care physicians in limiting access to secondary care is considered a benefit to the health service. Therefore, it is important to establish specialized clinics in primary health care centers with suitable resources and services to treat and control patients to reduce the pressure on the tertiary hospitals and save cost and time.…”

The Role and Impact of Reference Laboratories in the Primary Health Care System

“…This case of a public health pathology strategy provides a foundation for transition from the central-ized strategy towards the locally available strategy, which may contribute to enhancing timely health-care delivery in rCHCs and smaller laboratories and to recovering the economy and life. The goal of this study is to contextualize what reference laboratories provide in secondary health-care settings to better understand what services could be recommended for implementation and the information required for laboratories to determine their role in testing for a new clinic [23]. Changes to clinical pathways and additional resources can have significant impacts on CHCs and need to be considered when implementing POC tests.…”

Assessment of Accountable Care Organization Strategies: A Qualitative Approach

“…ACOs can establish mega primary health centers (PHCs) that provide a comprehensive range of services. These centers can include primary care providers, specialists, diagnostic services, and other resources necessary to provide high-quality care to patients (Tashkandi et al, 2021).…”