Impact of point-of-care implementation of Xpert® MTB/RIF: product vs. process innovation.
Int J Tuberc Lung Dis
; 19(9): 1084-90, 2015 Sep.
Article
em En
| MEDLINE
| ID: mdl-26260830
ABSTRACT
BACKGROUND:
Both product innovation (e.g., more sensitive tests) and process innovation (e.g., a point-of-care [POC] testing programme) could improve patient outcomes.OBJECTIVE:
To study the respective contributions of product and process innovation in improving patient outcomes.DESIGN:
We implemented a POC programme using Xpert(®) MTB/RIF in an out-patient clinic of a tertiary care hospital in India. We measured the impact of process innovation by comparing time to diagnosis with routine testing vs. POC testing. We measured the impact of product innovation by comparing accuracy and time to diagnosis using smear microscopy vs. POC Xpert.RESULTS:
We enrolled 1012 patients over a 15-month period. Xpert had high accuracy, but the incremental value of one Xpert over two smears was only 6% (95%CI 3-12). Implementing Xpert as a routine laboratory test did not reduce the time to diagnosis compared to smear-based diagnosis. In contrast, the POC programme reduced the time to diagnosis by 5.5 days (95%CI 4.3-6.7), but required dedicated staff and substantial adaptation of clinic workflow.CONCLUSION:
Process innovation by way of a POC Xpert programme had a greater impact on time to diagnosis than the product per se, and can yield important improvements in patient care that are complementary to those achieved by introducing innovative technologies.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Escarro
/
Tuberculose Pulmonar
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Avaliação de Processos em Cuidados de Saúde
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Testes Imediatos
Tipo de estudo:
Diagnostic_studies
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Evaluation_studies
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Observational_studies
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Prevalence_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Asia
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article