Lipid distributions in the Global Diagnostics Network across five continents.

AIMS: Lipids are central in the development of cardiovascular disease, and the present study aimed to characterize variation in lipid profiles across different countries to improve understanding of cardiovascular risk and opportunities for risk-reducing interventions. METHODS AND RESULTS: This first collaborative report of the Global Diagnostics Network (GDN) evaluated lipid distributions from nine laboratory organizations providing clinical laboratory testing in 17 countries on five continents. This cross-sectional study assessed aggregated lipid results from patients aged 20-89 years, tested at GDN laboratories, from 2018 through 2020. In addition to mean levels, the World Health Organization total cholesterol risk target (<5.00 mmol/L, <193 mg/dL) and proportions in guideline-based low-density lipoprotein cholesterol (LDL-C) categories were assessed. This study of 461 888 753 lipid results found wide variation by country/region, sex, and age. In most countries, total cholesterol and LDL-C peaked at 50-59 years in females and 40-49 years in males. Sex- and age-group adjusted mean total cholesterol levels ranged from 4.58 mmol/L (177.1 mg/dL) in the Republic of Korea to 5.40 mmol/L (208.8 mg/dL) in Austria. Mean total cholesterol levels exceeded the World Health Organization target in Japan, Australia, North Macedonia, Switzerland, Germany, Slovakia, and Austria. Considering LDL-C categories, North Macedonia had the highest proportions of LDL-C results >4.91 mmol/L (>190 mg/dL) for both females (9.9%) and males (8.7%). LDL-C levels <1.55 mmol/L (<60 mg/dL) were most common among females in Canada (10.7%) and males in the UK (17.3%). CONCLUSION: With nearly a half billion lipid results, this study sheds light on the worldwide variability in lipid levels, which may reflect inter-country differences in genetics, lipid testing, lifestyle habits, and pharmacologic treatment. Despite variability, elevated atherogenic lipid levels are a common global problem, and these results can help inform national policies and health system approaches to mitigate lipid-mediated risk of cardiovascular disease.

Improvement in laboratory test turnaround times for inpatients following move to hub and spoke model of delivery.

OBJECTIVES: The relative merits of hub and spoke models of service delivery are often debated, but accessing data on how they may benefit service delivery can be difficult, and may hinder the adoption of a model which can benefit the health community. Our aim was to provide objective data that would either support or refute one potential benefit of service redesign, namely the effect on turnaround times within the acute hospital. DESIGN AND METHODS: Data on turnaround times for sequential requests containing creatinine as a request item received from inpatient locations at two acute hospitals were extracted from the laboratory computer system. Monthly data was collected for a period of 5 months prior to and the same 5 month period following the service redesign. Data was subjected to statistical process control (SPC) analysis. RESULTS: There was a statistically significant reduction (P<0.05) in the average turnaround time of at least 29% for routine requests and 22% for urgent requests, accompanied by a statistically significant reduction (P<0.05) in upper control limits of least 46% - improving the predictability of result availability and reducing the 95% confidence interval for turnaround times. CONCLUSIONS: Adoption of a "hub and spoke" model has the potential to support laboratories in improving both urgent and non-urgent turnaround times in a cost-efficient manner within acute hospitals, and reduce the variability in turnaround time.