Identifying Preanalytic and Postanalytic Laboratory Quality Gaps Using a Data Warehouse and Structured Multidisciplinary Process

Abstract

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.

Technology-Enabled Outreach to Patients Taking High-Risk Medications Reduces a Quality Gap in Completion of Clinical Laboratory Testing

“…22 Among 1520 ambulatory patients at KPCO taking methotrexate between January 1, 2014 and September 9, 2016, 60.7% had at least 1 ALT testing gap exceeding 100 days, although only 14% had at least 1 ALT testing gap exceeding 210 days. 21 Similar timeliness of testing gaps were noted for AST, CBC, and SCr. The fact that most patients eventually completed testing reflected our "safety net" resource-intensive process.…”

“…The research team previously described the multidisciplinary process by which the Kaiser Permanente Colorado (KPCO) MDW, the Virtual Data Warehouse (VDW), was used to characterize quality gaps in laboratory testing and to select one gap for a laboratory-based intervention. 21 The team selected laboratory monitoring of high-risk medications in ambulatory care, specifically alanine aminotransferase (ALT), aspartate aminotransferase (AST), complete blood count (CBC), and serum creatinine (SCr) testing among the rheumatology patient population receiving conventional or targeted synthetic disease-modifying antirheumatic drugs (conventional DMARDs; cDMARDs) and CBC testing among the rheumatology patient population receiving tumor necrosis factor (TNF) and non-TNF biologic antirheumatic drugs (biologic DMARDs; bDMARDs). Throughout this paper the more general term "antirheumatic agents" is used to refer to both conventional and biologic antirheumatic agents, while cDMARD or bDMARD refers to the indicated antirheumatic agents.…”

Use of the WISN method to assess the health workforce requirements for the high-volume clinical biochemical laboratories

“…Medical laboratories have been afflicted with shortages and skill-mix adequacy of laboratory professionals for many decades [3]. Still, their capacity and equitable distribution have been a rare focus of the research for many decades despite the workplace's technology progress [4,5] before the COVID-19 pandemic, during which rapid and accurate testing of large number of samples is necessary. For the second year in a row with the COVID-19 pandemic, laboratory managers as transformational leaders are trying to meet the growing demand for services within limited laboratory budgets, mainly by improving productivity and clinical excellence (e.g., shortening turnaround times, using advanced technologies, maintaining service quality and safety, and customer satisfaction) [6].…”

Use of The WISN Method to Assess the Health Workforce Requirements for the High-volume Clinical Biochemical Laboratories

“…Medical laboratories have been a icted with shortages and skill-mix adequacy of laboratory professionals for many decades [3]. Still, their capacity and equitable distribution have been a rare focus of the research for many decades despite the workplace's technology progress [4,5] before the COVID-19 pandemic, during which rapid and accurate testing of large number of samples is necessary. For the second year in a row with the COVID-19 pandemic, laboratory managers as transformational leaders are trying to meet the growing demand for services within limited laboratory budgets, mainly by improving productivity and clinical excellence (e.g., shortening turnaround times, using advanced technologies, maintaining service quality and safety, and customer satisfaction) [6].Laboratory managers have long struggled with sta ng formula due to the complex nature of laboratory activities [7].…”