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PubMed · 10143165

Developing key laboratory performance indicators: a feasibility study. Potential roles for CLMA.

Abstract

The challenges (and opportunities) for laboratory management posed by cost control, managed care, information networks, and health system integration call for both short- and long-term responses. In rapidly evolving markets, new measures are needed to assess how effectively laboratories manage the information process. The objective of the research described in this report was to determine the feasibility of a system that would collect, analyze, and report nationally standardized indicators of laboratory performance and that would meet the needs of health system executives, managed care plans, and external agencies, as well as laboratory service providers. The feasibility study involved extensive interviews with a broad cross-section of the health-care industry, as well as a literature search of journals, newspapers, marketing brochures, and other documents addressing comparative performance assessment in the health-care industry. The study investigated the current status of comparative performance assessment in the health-care industry. We found that there are several important lessons laboratorians can learn from the experiences of others involved in key indicator development and performance assessment: Key indicators must measure those aspects of performance that are important and meaningful to laboratory customers. Indicators developed for laboratory management performance should be compatible with performance criteria established in other health-care sectors, particularly those that represent managed care and other customers of laboratory services. The identification of participants in the process of consensus development should be as inclusive as possible if the indicators are to gain wide acceptance. Standardized definitions and data collection rules are essential for data comparability. Credibility is key. It is necessary that the chosen measures be not only reliable, valid, and easy to implement, they must also be demonstrably related to patient care outcomes. In order to make meaningful interlaboratory comparisons, an effective system for peer groupings is also required. Currently available systems for collecting and reporting laboratory performance data were also reviewed.(ABSTRACT TRUNCATED AT 400 WORDS)

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BibTeXRIS

J Zinn, T Getzen. Developing key laboratory performance indicators: a feasibility study. Potential roles for CLMA.. https://pubmed.ncbi.nlm.nih.gov/10143165/

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Management of severe hypokalemia in hospitalized patients: a study of quality of care based on computerized databases.

BACKGROUND: While administrative databases are used to assess general indicators of quality of care, a detailed audit of the process of clinical care usually requires review of hospital medical records. OBJECTIVE: To evaluate the feasibility of assessing the management of severe hypokalemia using computerized administrative and laboratory databases. METHODS: The study included all patients hospitalized in 1997 who experienced serum potassium levels of less than 3.0 mmol/L at Hadassah University Hospital, Jerusalem, Israel, a tertiary care center. Using the computerized databases, we measured the following: (1) whether a subsequent serum potassium test was performed, (2) time to the subsequent test and to normalization of the serum potassium level, (3) achievement of normokalemia, and (4) in-hospital mortality. In a random subsample of 100 patients, these measures were compared with the blinded assessment of the quality of medical management of hypokalemia, as determined from medical records, using predetermined criteria for adequate management. RESULTS: The computerized databases revealed that severe hypokalemia occurred in 866 patients (2.6% of the yearly hospitalizations): 55 patients (6.4%) had no subsequent serum potassium levels measured, and 260 (30.0%) were discharged from the hospital with a subnormal potassium level. The mean time to a subsequent test was 20 hours, and to normokalemia, 50 hours; both intervals varied by department. In-hospital mortality was 20.4%, or 10-fold that of the entire hospitalized population. A review of hospital medical records revealed inadequate clinical management of hypokalemia in 24%, which was associated with nonperformance of a subsequent test (likelihood ratio, 8.4), failure to normalize the serum potassium level (likelihood ratio, 4.2), discharge from the hospital with a subnormal potassium level (likelihood ratio, 2.1), and in-hospital death (likelihood ratio, 2.5), all of which could be determined by the computerized databases. CONCLUSIONS: The computerized laboratory database is useful in ascertaining the prevalence of severe hypokalemia and in assessing shortcomings in its management. Databases can be used to derive valid and efficient measures of the quality of the clinical management of electrolyte disorders.

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