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A new resource developed by the AACC Academy and Science and Practice Core Committee (SPCC) recommends 13 better tests and/or diagnostic practices that medical professionals should implement in place of commonly misused tests. The aim is to help labs, clinicians, and hospitals select appropriate tests for their patients, providing optimal care while reducing costs.
This resource is a product of the Test Utilization Subcommittee, a joint effort between the Academy and SPCC. “Laboratorians should share this document with clinicians and discuss with them how to use these documents as guidance for selection of optimal tests and elimination of unnecessary or misused tests,” Yusheng Zhu, PhD, DABCC, FADLM, professor of pathology and lab medicine, and pharmacology at Penn State University Hershey Medical Center and the subcommittee’s chair, told CLN Stat.
The 13 recommendations address the following topics:
Some of these tests (CKMB and amylase, for example) are not very specific, said Zhu. “More specific tests are available, such as cardiac troponin and lipase.” Other assays, like bleeding time and fetal lung maturity, are obsolete.
Each section discusses the uses and limitations of the test in question and provides guidelines for testing. For example, in the case of the 72 hour quantitative fecal fat test, the document advises that the test’s clinical value is insignificant. Intended to assess increased fat excretion in stool, this test might suggest that a patient has malabsorption. Results, however, won’t provide additional information on malabsorption causes.
The section on qualitative serum hCG tests offers some considerations about cost. “Serum quantitative testing is more accurate, but also more costly than qualitative testing,” according to the document. Clinicians should use this test if they suspect a patient might be pregnant; however, they should not use serum hCG to determine pregnancy viability or as a trophoblast or gonadal tumor marker. For the latter purpose, the document recommends a quantitative hCG instead.
The AACC Academy Council had initially selected a dozen laboratory utilization documents from about 100 potentially misused tests proposed by SPCC, explained Zhu. Each council member reviewed one to two documents and made revisions based on the evidence in the literature. The council initially approved a few of these laboratory utilization documents.
To make the process more efficient, the council formed a special task force that included three members from SPCC and four members from the Academy. This group continues to meet virtually once a month to identify authors to write, review, and revise draft documents and approve them. Following the current set of 13 optimal utilization documents, the group plans to publish five to 10 new documents each year, according to Zhu.