Value Means More Than Cost screening Tests, continued from page 4 embrace the study’s findings. “If having too many choices leads to confusion, the study … demonstrates that not having enough choice may lead to inaction when the only choice is colonoscopy,” he wrote. “When it comes to colorectal cancer screening, providing an option other than colonoscopy <strong>for</strong> our patients is not overwhelming, but necessary.” Levin is a research scientist at the Kaiser Permanente Northern Cali<strong>for</strong>nia Division of Research and a gastroenterologist at Kaiser Permanente Medical Center, Walnut Creek. When Evidence Agrees, the Lab Can Shine When physician groups and others in healthcare talk about overuse of lab tests, it Cerilliant Quality ISO GUIDE 34 ISO/IEC 17025 ISO 13485 ISO 9001 GMP/GLP 6 CliniCal laboratory news <strong>June</strong> <strong>2012</strong> can sound like bad news <strong>for</strong> the lab. However, even when the quest <strong>for</strong> high-value care is driven by <strong>for</strong>ces outside the lab, sometimes the results promote lab testing over other options. For example, highsensitivity D-dimer testing is a clear winner in the Choosing Wisely campaign, as well as the ACP High-Value, Cost-Conscious Care Initiative. Both lists emphasize that physicians should chose a high-sensitivity D-dimer assay instead of imaging studies <strong>for</strong> patients with low pretest probability of venous thromboembolism (VTE) (See Box, p. 3). D-dimer testing is an example of how clear evidence <strong>for</strong> clinical utility of an assay can boost recognition of the value of the lab’s contribution to patient care. Not Starting materials are a critical component of calibrators, controls and reagents. Unlike research chemicals, Cerilliant Certifi ed Spiking Solutions ® are designed, manufactured and tested <strong>for</strong> their intended use, and are backed by our comprehensive COA. Cerilliant…when results matter Cerilliant Quality ISO GUIDE 34 ISO/IEC 17025 ISO 13485 ISO 9001 GMP/GLP results are only as accurate as your calibrators Tamara Tarbox, MST QUALITY CONTROL Kenan Yaser, MS SYNTHESIS OPERATIONS Martha Liu, PhD SYNTHESIS OPERATIONS coincidentally, it also is an area where laboratorians have worked with physicians on clinical practice guidelines. For example, a representative from AACC contributed to the <strong>American</strong> College of Chest Physicians’ (ACCP) 9th edition of its authoritative clinical practice guidelines <strong>for</strong> prevention and treatment of VTE, and AACC was invited to review and endorse the guidelines (Chest <strong>2012</strong>;141:S). The collaboration with ACCP grew out of the involvement of AACC’s Evidence-Based Laboratory Medicine Committee with the Agency <strong>for</strong> Healthcare Research and Quality. AACC endorsed the guidelines out of a desire to emphasize the utility of high- sensitivity D-dimer testing versus more costly and complex interventions, according to Stephen Kahn, PhD, chair of the AACC committee. “We were pleased to work with the <strong>American</strong> College of Chest Cerilliant Quality For a complete list of our Certifi ed Spiking Solutions ® <strong>for</strong> <strong>Clinical</strong> Applications, visit Cerilliant.com. • Analgesics • Antidepressants • Antiepileptics • Antipsychotics • Caffeine-related Drugs • Cardiac Drugs • Catecholamines • Hormones — Female — Male — Neonatal — Thyroid • Immunosuppressants • NSAIDs ISO GUIDE 34 ISO/IEC 17025 ISO 13485 ISO 9001 GMP/GLP • Vitamins (including Vitamin D) Visit Cerilliant.com or call: 800/848-7837 USA or CANADA 512/238-9974 INTERNATIONAL © <strong>2012</strong> Cerilliant Corporation 06/12 5006 <strong>Clinical</strong> Lab News Ad_FINAL.indd 1 5/8/12 1:15 PM Physicians. They are really a top-notch association when it comes to guideline development and are the premier experts in this area, recognized internationally by people in evidence-based medicine,” Kahn said. “In addition, one of AACC’s long-term goals is to work more closely with clinical organizations and be recognized as an important player when it comes to issues involving laboratory medicine.” Kahn is a professor of pathology and director of laboratories at Loyola University Medical Center in Maywood, Ill. Considering the difficulty physicians have with understanding and communicating complex in<strong>for</strong>mation about screening tests, the healthcare community needs the help of laboratorians, said USPSTF Chair, Virginia Moyer, MD, MPH. “People in the lab should be thinking about how they can best communicate with their customers, but that obviously goes both ways. If the people ordering the test can be clear about why and in whom they’ve ordered it, then the people reporting the results can be much more helpful in the interpretation of the results,” she said. Moyer is also a professor of pediatrics at Baylor College of Medicine in Houston. In an editorial that accompanied the study on physician’s understanding of screening statistics, Moyer argued that the research underscored the need <strong>for</strong> highquality, evidence-based guidelines, and noted that many organizations have moved to align with the Institute of Medicine’s (IOM) standards <strong>for</strong> guideline development (Ann Intern Med. <strong>2012</strong>;156:392– 393). AACC’s National Academy of <strong>Clinical</strong> Biochemistry is among the guideline development bodies that have embraced the IOM recommendations. Moyer said that she also looks to researchers in the lab community <strong>for</strong> continued improvements in the tests themselves. “There are many, many screening tests which we sure wish were better,” she said. “Part of it is that right now, many of them are a little bit like x-rays—they’re shadows. PSA is an example. It rises not only in prostate cancer, but also in anything that irritates the prostate. It says something is going on, but not what. And it doesn’t even always rise when something is wrong.” According to Kahn, the emphasis <strong>for</strong> laboratorians will not be in terms of more testing or less, but making sure the right tests are used at the right time. This means a focus on evidence-based laboratory medicine, and more interdisciplinary collaborations like AACC’s contribution to the ACCP guidelines. Laboratorians need to be objective about their own lab services and try to keep abreast of the key clinical practice guideline recommendations to be considered in making changes in clinical practice at their own institutions. CLN next month in CLN modern sepsis Diagnosis
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