Laboratorio de diagnóstico clínico y/o de vigilancia epidemiológica: norma técnica No. 22-2019-DRACES / Laboratory for clinical diagnosis and / or epidemiological surveillance: technical standard No. 22-2019-DRACES

La tinta del documento está bastante opaca. DRACES [Departamento de Regulación, Acreditación y Control de Establecimientos de Salud] Este documento tiene como objeto: "la regulación, autorización y control de los laboratorios de diagnóstico clínico y/o de vigilancia epidemiológica, en concordancia con el Reglamento para la Regulación, Autorización, Acreditación y Control de Establecimientos de Atención para la Salud, Acuerdo Gubernativo 376-2007." Es de carácter obligatorio, por lo que se aplica tanto al sector público, privado, social o subsector de la seguridad social, en todo el territorio nacional. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada clínica, incluidos el equipo y recurso humano y técnico. En el capítulo II, incluye una clasificación del nivel de laboratorios, describiendo sus características, servicios, horarios, materiales técnicos y equipos.

Assessment of laboratory capacity of public secondary health facilities in performing assay of selected epidemic-prone diseases in Oyo State, Nigeria.

This study assessed the capacity of public secondary facility-based laboratories in conducting diagnostic tests for selected epidemic-prone diseases in Oyo State, Nigeria. A descriptive cross-sectional study was conducted in 17 secondary facility-based laboratories in Oyo State. Capacity was assessed on a 100-point scale in which scores were rated low (≤49%), fair (50-79%) and good (≥80%). Diagnostic testing capacity for bacterial meningitis, cholera, and measles was "low" in all the laboratories. The reasons reported for laboratories not conducting diagnostic tests for the selected diseases included inadequate instruments, unavailable reagents, and clinicians' failure to request those diagnostic tests. Laboratory capacity to perform diagnostic tests for the selected diseases was low in Oyo State secondary hospitals. There is a need for the provision of modern instruments and reagents, as well as clinician laboratorian quality assurance programs, to improve diagnostic services relating to the selected diseases.

[Analysis of effects of pharmacotherapy on certain parameters of clinical laboratory diagnostics].

AIM: To study effects of pharmaceutical products on the results of clinical and laboratory diagnostics. MATERIALS AND METHODS: The list of vitally important pharmaceuticals, clinico-pharmacological articles of the National registry of medicinal products, formulary articles from the Federal guidelines on the use of pharmaceutical products. Formulary system, instructions for use of individual pharmaceutical products. Systemic and information-based approaches, logical and comparative analysis were used throughout the study. RESULTS: Results of analysis enabled the authors to draw up separate lists of pharmaceuticals based on their influence on parameters of clinical laboratory diagnostics, such as the list of pharmaceuticals exerting marked effect on diagnostic characteristics (blood properties, primary and coagulative hemostasis, serum enzymes), the list of pharmaceuticals exerting marked effect on systematized laboratory characteristics; the list of pharmaceuticals exerting no effect on clinical and laboratory diagnostics; the list of pharmaceuticals whose effect on diagnostic characteristics awaits clarification. CONCLUSION: The results of the study can be used for the development of recommendations on pharmaceutical counseling and rational choice of pharmaceutical products being prescribed to concrete patients.

Evaluating congruence between laboratory LOINC value sets for quality measures, public health reporting, and mapping common tests.

Laboratory test results are important for secondary data uses like quality measures and public health reporting, but mapping local laboratory codes to LOINC is a challenge. We evaluated the congruence between laboratory LOINC value sets for quality measures, public health reporting, and mapping common tests. We found a modest proportion of the LOINC codes from the Value Set Authority Center (VSAC) were present in the LOINC Top 2000 Results (16%) and the Reportable Condition Mapping Table (52%), and only 25 terms (3%) were shared with the Notifiable Condition Detector Top 129. More than a third of the VSAC Quality LOINCs were unique to that value set. A relatively small proportion of the VSAC Quality LOINCs were used by our hospital laboratories. Our results illustrate how mapping based only on test frequency might hinder these secondary uses of laboratory test results.

[Laboratory alert value reporting by the clinical laboratory at an academic medical network]. / Aviso de valores de alerta por parte del laboratorio clínico en una red de salud universitaria.

BACKGROUND: An alert value is a result suggesting that the patient is at imminent danger unless appropriate remedial actions begin promptly. Report of alert values (AV) by the clinical laboratories has taken special relevance in recent years due to its contribution to patient's care. AIM: To report results of AV informed during 2007 within the Health Network of the Pontificia Universidad Católica de Chile. MATERIAL AND METHODS: Analysis of AV recorded in a centralized database of the laboratories of the health network, between January and December, 2007. RESULTS: Total number of AV was 5.366, which represented 0.3% of total examinations and corresponded mainly to the clinical chemistry area. Potassium levels generated the higher number of AV detected, followed by positive blood cultures. Eighty two percent of AV corresponded to hospitalized patients. The greater number of AV was reported to intermediate and intensive care services. Thirty two percent of AV was informed to the physician or professional in charge of the patient within 5 minutes of obtaining the results and 79% within 30 minutes. CONCLUSIONS: To obtain a real impact on patient management, it is fundamental to shorten the lapse between the obtainment of tests results and the warning, supported on appropriate computerized systems, and to spread the procedure to all personnel involved in patient's care.

A modified method of activity-based costing for objectively reducing cost drivers in hospitals.

OBJECTIVES: Activity-based costing (ABC) is widely used to precisely allocate indirect costs to medical services. In the ABC method, the indirect cost is divided among the medical services in proportion to the volume of "cost drivers", for example, labor hours and the number of hours of surgery. However, the workload of data collection of cost drivers can be time-consuming and a considerable burden if there are many cost drivers. The authors aim to develop a method for objectively reducing the cost drivers used in the ABC method. METHODS: In the ABC method, the cost driver is assigned for each activity. We assume that these activities and cost drivers are the best combination. Our method, that is cost driver reduction (CDR), can objectively select surrogates of the cost drivers for each activity in ABC from candidate cost drivers. Concretely, the total indirect cost of an activity is temporarily allocated to the medical services using each candidate of cost drivers. The difference between the costs calculated by each candidate and the proper cost driver used in ABC is calculated to evaluate the similarity by the evaluation function. RESULTS: We estimated the cost of laboratory tests using our method and revealed that the number of cost drivers could be reduced from seven in the ABC to four. Similarly, the results of cost estimation obtained by our method were as accurate as those calculated using the ABC. CONCLUSIONS: Our method provides two advantages compared to the ABC method: 1) it provides results that are as accurate as those of the ABC method, and 2) it is simpler to perform complicated estimation of hospital costs.

Clinical laboratory billing: superfluous requirements without justification?

Congress occasionally passes new laws that affect how clinical laboratories handle test orders from physicians and, subsequently, process the billing for tests. Once a bill is signed into law, it is forwarded to administrative agencies, which draft regulations and administrative procedures, under which the intentions of Congress are carried out. In the case of laboratory test ordering and billing, the Centers for Medicare and Medicaid Services (CMS) has the greatest influence over how these regulations and procedures are defined. Unfortunately, in many cases, billing rules have been promulgated in ways that create the need for hospitals and commercial laboratories to expend huge sums of money to bill within the confines of the administrative rules; cause clinical laboratories to suffer from omissions and mistakes of other parties who are part of the patient care process but are not accountable for the billing information they provide to laboratories; and, frankly, in some respects, simply defy common sense.

Laboratory services regulations impact national coverage decisions, HIM.

This is Part 2 of a two-part article on laboratory services regulations. Part 1, which appeared in the September Journal of AHIMA, dealt with the administrative policies contained in these regulations. Part 2 addresses the specific national coverage decisions that were developed as part of this regulatory process. For more information on each coverage policy, review Addendum B of the regulations.

Laboratory services regulations carry HIM implications.

This is Part 1 of a two-part article on national coverage and policies for clinical diagnostic laboratory services payable under medicare Part B. Part 1 concentrates on the administrative policies. Part 2, which will appear in the October issue of the Journal, will focus on the national coverage policies developed for individual clinical diagnostic laboratory tests. For additional information regarding the new administrative policies, see the Centers for Medicare & Medicaid Services (CMS) Program Memorandum AB-02-030, which was issued to all Medicare contractors on March 5, 2002.

Detection and documentation of DRG-relevant comorbidities using laboratory tests.

Germany will soon begin per case payment by DRG, and preparations are in progress in most hospitals and insurance companies. The Academic Teaching Hospital Munich-Schwabing in Munich decided to explore coding strategies by considering the impact of diagnoses that could be detected by pathology tests. An Australian database was analysed. We detected "discriminating" diagnoses--that is, diagnoses that could be found in level A or B DRGs, and not in the respective lower severity DRG. After isolating 584 diagnoses, they were rated by a laboratory specialist, to determine whether they could be proved by pathology tests. 187 diagnoses were selected in this way. In the next step, theoretical cases were generated and grouped. 157 diagnoses were found to produce a switch to a higher DRG. The diagnoses, the DRGs and the respective laboratory tests were then arranged in a small MS-Excel program to allow comfortable browsing. The overall success rate of 84% shows that laboratory medicine can contribute to correct coding for DRGs.

Clarifying selected CPT modifiers.

This discussion includes only 20 percent of the modifiers available for physician reporting, but could account for 80 percent of modifiers assigned for physician services. Modifier -91 was the only new modifier introduced in CPT 2000 and it is used to report a repeat clinical diagnostic laboratory test. It is not to be used when confirming initial results or for any other reason other than a clinical need to repeat the test for the same patient on the same day. Success with CPT modifier reporting requires a thorough review of CPT guidelines and some detective work for identifying health plan requirements for modified codes.