The terms patient-centered care, precision medicine, and individualized healthcare abound in today’s healthcare environment. While perhaps having slightly different meanings they all mean delivering effective and appropriate care to patients—the right care, at the right time, to the right patient.
Clinical laboratories support this concept through their role in assessing, implementing, and maintaining high quality point-of-care testing (POCT). While clinical laboratorians are well-versed in all things POCT, fitting POCT into business concepts like value-added, efficiencies, and multidisciplinary collaborations is a relatively new way concept.
In Tuesday’s morning symposium, “Continuous Improvement of your POCT Program: Patient-Centered Care, Reducing Overall Healthcare Costs, and Helping Meet The Goals of Healthcare,” a trio of POCT aficionados shared their experiences adding value to the healthcare process using POCT.
Rob Nerenz, PhD, started the discussion noting that fragmented care processes often result in missed opportunities to efficiently address patient needs. Unfortunately, when the missed opportunities are identified, the impact of proposed fixes are typically not fully considered.
Nerenz described his experience leading a multi-disciplinary team of laboratorians, physicians, nurses, phlebotomists, purchasers, and IT staff in tackling issues with hemoglobin A1c testing performed prior to endocrine clinic visits. Initially they assumed that placing POCT devices in the clinic would fix the problem. However, looking at the whole care delivery process—asking questions about medical necessity, regulatory compliance, costs vs. benefits, and what other lab-related testing was involved—they realized that changes to how patients entered the hospital and moved from phlebotomy to clinic was the root cause.
Simple changes in pre-visit ordering of lab tests and communications with patients on where to park and move through the facility would dramatically improve outcomes, without adding POCT.
Nicole Tolan, PhD, described a case with an off-campus clinic and sample transport issues to the core laboratory. Without results to assist with decision-making while the patient was present, patients were lost to follow-up and the clinic faced a loss in revenue by not meeting pay for performance goals associated with managing diabetic patients. The increased cost of providing POCT improved both patient and revenue outcomes. Nicole quoted Charles Matthews from his AACC Lab Leaders webinar in which he noted that “lab spend can translate to reduction in total medical care cost.”
Tolan noted that the literature is mixed on the value of POCT, but many of the studies looked at limited components. She reminded attendees that looking at total costs and patient outcomes was important to fully understand value. If POCT wasn't producing actionable information and required additional follow-on testing, it likely would not translate into improved outcomes.
Next, Brenda Suh-Lailam, PhD, described three ways to capture the value of POCT. The first involved thorough review and process mapping to look at factors impacting decision-making in an imaging clinic. The mapping provided insight into which steps truly resulted in delays versus those that did not require improvement. In one example, implementing POCT creatinine testing in a clinic reduced wait times from more than 100 minutes to less than 20 minutes.
This time savings reduced wait times for imaging equipment, and more importantly, patient cancellations when they were unable to wait.
Similar projects with process mapping and multi-disciplinary teams found ways to improve the quality of POCT. Key to these projects was to clearly identify stakeholders, provide data from pilot projects, and consider feedback from actual users to convince the stakeholders of value.