CEO SUMMARY: In convening the 2007 Institute “Managing for Better Health,” in Atlanta last week, the Division of Laboratory Systems of the CDC invited a broad spectrum of healthcare experts and policymakers to participate. The ambitious goal was to facilitate discussions involving stakeholders such as employers, payers, policymakers, clinicians, and others to identify ways that laboratory medicine could more effectively leverage outcomes and patient care.
IT IS WIDELY RECOGNIZED THAT LABORATORY MEDICINE can play a more effective role in helping the American healthcare system improve the quality of care, reduce medical errors, and improve patient satisfaction. Yet laboratory medicine seldom has a place at the table when policymakers develop new plans and programs.
To help change this situation and give laboratory medicine wider recognition and involvement in achieving national health policy goals, the Division of Laboratory Systems of the Centers for Disease Control and Prevention (CDC) convened the 2007 Institute “Managing for Better Health” in Atlanta on September 24-26. By invitation, approximately 80 people participated to identify strategies and opportunities for laboratory medicine to improve collaboration and involvement.
“Groundwork was laid to lift the profile and contribution of laboratory medicine within the American healthcare system,” stated D. Joseph Boone, Ph.D., Acting Director, Division of Laboratory Systems, NCPDCID at the CDC. “This 2007 institute brought together a group of national healthcare leaders specifically to interact with laboratory professionals. The goal was to identify ways that the American healthcare system could leverage laboratory testing services to make faster progress on such goals as reducing medical errors, improving clinical outcomes, and increasing patient satisfaction.”
Different Health Stakeholders
The 2007 institute was organized around three theme groups: collaborations, measures, and futures. In a series of facilitated sessions, participants worked to identify healthcare priorities in which laboratory medicine had the potential to contribute to significant improvements in healthcare outcomes and patient safety in ways that are cost effective for the American healthcare system.
Because of the cross section of healthcare interests represented, there was intense discussion across a wide range of topics and opportunities. “The hard work was to take a priority that has broad consensus, like ‘improve health outcomes,’ and drill down into specific areas of care where there was both a major opportunity to advance and improve, and where laboratory medicine would be an essential element in triggering those gains,” observed Boone.
Emphasizing Lab Medicine
“Over the course of these individual sessions, there was repeated recognition that laboratory medicine’s greatest contribution, particularly in the short term, was at two places in the clinical continuum,” stated Elissa Passiment, Ed.M., who was Chair of the Institute Committee. She is also Executive Vice President of the American Society for Clinical Laboratory Science (ASCLS) in Bethesda, Maryland.
“The first place is that moment when a clinician must decide whether to order a laboratory test and, if so, what the right lab tests should be,” explained Passiment. “The second place is when the laboratory results are reported to the clinician and it is time for the clinician to use these lab test results to decide an appropriate course of action for the patient.
“Many laboratory professionals recognize these points as the pre-pre-analytical and post-post-analytical steps,” she noted. “It was also recognized at the institute that it is not common for laboratory professionals to regularly consult, as appropriate, with clinicians at these stages in the clinical continuum. Yet, if laboratory medicine expertise can become part of the clinical consultation at these points, it was agreed that significant improvement in care outcomes could result for many high-profile diseases and chronic health conditions.”
Action Items Identified
Working from this framework, participants developed agreement that three or four action items would be worth pursuing as a direct result of the institute and the interaction of individuals who participated. “One action item is to develop a framework with which to review, catalogue, and create evidence-based measures and practices in laboratory medicine that emphasize the added value of these services and produce quality patient outcomes,” stated Passiment. “These evidence-based guidelines would then form the basis for collaborative efforts. Physicians, payers, policymakers and laboratory professionals would work together to educate and encourage appropriate clinical use of these evidence-based guidelines.
“Another actionable recommendation was to implement models of patient care that integrate clinical consultation provided by laboratory medicine professionals in the selection of laboratory services and the interpretation of test results,” she continued. “A third action item—and a logical complement—was to develop courses and programs to train and educate clinicians to better utilize evidence- based guidelines, including laboratory tests, in a patient-centered care model.”
Under the aegis of the CDC, the 2007 institute committee is preparing a sum- mary of the proceedings for public release. A major objective of the institute was that the findings of the participants be translated directly into actionable projects, pursued by a collaborative task force made up of interested organizations and individuals. It is expected that several ad hoc working groups will be assembled to accomplish this task.
Call For Resources
As part of this effort, the institute committee will call on the laboratory profession for two needed resources. One is the active involvement of qualified individuals from all parts of healthcare to collaborate on pursuing the action items. The second is sources of funding to enable these teams to meet, to conduct necessary studies, and to publish findings. Anyone with an interest in contributing to this effort and funding these teams can contact the individuals listed below.