Identifying Preanalytic and Postanalytic Laboratory Quality Gaps Using a Data Warehouse and Structured Multidisciplinary Process.
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 th...
| Published in: | Archives of Pathology & Laboratory Medicine Vol. 143; no. 4; pp. 518 - 525 |
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| Main Authors: | , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
College of American Pathologists
Apr2019
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=135659593&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 135659593 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00039985 1FS jtl: Archives of Pathology & Laboratory Medicine issn: 00039985 maglogo: N pubinfo: dt: Apr2019 vid: 143 iid: 4 pid: 2550 pub: College of American Pathologists place: Northfield, Illinois artinfo: ui: 135659593 135659593 135659593 10.5858/arpa.2018-0093-OA 135659593 ppf: 518 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Identifying Preanalytic and Postanalytic Laboratory Quality Gaps Using a Data Warehouse and Structured Multidisciplinary Process. aug: au: Raebel, Marsha A. Quintana, LeeAnn M. Schroeder, Emily B. Epner, Paul L. Shetterly, Susan M. Pieper, Lisa E. Bechtel, Laura K. Smith, David H. Sterrett, Andrew T. Chorny, Joseph A. Lubin, Ira M. affil: Institute for Health Research sug: subj: Clinical Laboratories Quality Improvement Multidisciplinary Care Team Data Warehouse Utilization Human Leaders Practice Guidelines Documentation Drug Monitoring Alanine Aminotransferase Blood Aspartate Aminotransferase Blood Blood Cell Count Creatinine Blood Antirheumatic Agents Therapeutic Use ab: 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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