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Complexities of Health Complexities of Health CareCare
Individual careIndividual care– Acute careAcute care– Preventive carePreventive care– Chronic careChronic care
Public health carePublic health care– Environmental HealthEnvironmental Health– Emerging infectious diseaseEmerging infectious disease– Life stagesLife stages
Acute Health Care Traditional foundation of individual Traditional foundation of individual
health carehealth care ChaoticChaotic Uninformed decisions madeUninformed decisions made
Lack of good data on appropriateness of Lack of good data on appropriateness of treatments, preventive strategies, and utilizationtreatments, preventive strategies, and utilization
BiasedBiased Slanted by special interest groupsSlanted by special interest groups
Subject to public opinionSubject to public opinion
Prevention Aging boomers are trying to avoid Aging boomers are trying to avoid
diseasedisease Demand for information and direct Demand for information and direct
access increasingaccess increasing Science and medicine still Science and medicine still
developingdeveloping Laboratory’s lack of information and Laboratory’s lack of information and
access drive customers elsewhereaccess drive customers elsewhere
Chronic Care
Demographics of health care consumer– Doubling of population over age 85
will occur twice by 2050 Health care “migration”
– From system of acute care to one of prevention and maintenance
– Maintenance is the new chronic care
Public HealthPublic Health
Safeguarding communitiesSafeguarding communities– Monitoring the environmentMonitoring the environment– Food safetyFood safety– Infectious diseaseInfectious disease– Emergency preparednessEmergency preparedness– Newborn ScreeningNewborn Screening– Linking with all health care settingsLinking with all health care settings
Challenges of Health CareChallenges of Health Care
ResourcesResources– MonetaryMonetary– FacilitiesFacilities– Information technologyInformation technology– ProfessionalsProfessionals
Successful interaction and Successful interaction and integration of all of these integration of all of these resourcesresources
Trends In Laboratory Medicine
1970’s – Push to automate1970’s – Push to automate Produce more data on growing number of testsProduce more data on growing number of tests
1980’s – Demand for faster turn-around 1980’s – Demand for faster turn-around timestimes
Near patient testing with traditional instrumentsNear patient testing with traditional instruments
1990’s – Push to miniaturize1990’s – Push to miniaturize Waived category expanded point of care technologyWaived category expanded point of care technology
2000’s – Demand for personal control2000’s – Demand for personal control Direct access Direct access ?OTC?OTC
Trends in Laboratory Medicine
Digital and virtual services changing how we work in microscopy
Drifting towards Diagnostic Services which combine diagnostic imaging and anatomic and clinical pathology– Joint reports for surgical specimens– Molecular imaging
Value of Laboratorians
Provide information for:Provide information for:– PreventionPrevention– DiagnosisDiagnosis– TreatmentTreatment– PrognosisPrognosis– RiskRisk– Appropriate utilizationAppropriate utilization
The Future Is BrightThe Future Is Bright
Laboratory testing provides patient-specific information necessary for the prevention, diagnosis, treatment, and management of disease or establishment of health.– Genetic testing, proteomics and
pharmacogenomics enhance utility of lab tests in personalized medicine
– Evidence based medicine and clinical pathways rely on lab tests
The Future Is BrightThe Future Is Bright
Laboratory data essential component if Health Information Technology is to be considered high functioning
Decision making at every level of health: prevention, acute and chronic requires laboratory information
Laboratories should be prepared to assume a greater advisory role and provide other support to promote informed self care by consumers.
Trend in Health Care
Patient centered carePatient centered care What is patient-centered? According to What is patient-centered? According to
Gerteis et al. Through the patients’ eyes: understanding and promoting patient-centered care. San Francisco: Jossey-Bass, 1993.
Patient Centered
– Respect for patients’ values, preferences, and expressed needs
– Information, communication, and education
– Physical comfort – Emotional support and alleviation of fear
and anxiety – Involvement of family and friends – Coordination and integration of care – Transition and continuity
Patient-Centered in Lab
A patient-centric testing cycle starts when a patient presents to a provider and ends with clinical action or self care based on test results; for us, this– Extends the pre-analytic and post-
analytic phases– Requires open communication and
education– Changes from traditional testing sites
Drivers for Change
Increasing numbers of people with multiple chronic conditions who require greater skill in self management and self testing.
Increasing availability of community-based retail sites for health care (e.g., in large national retail and pharmacy chains) expands direct access to affordable services.
Drivers for Change
Marketing of new and innovative testing technologies (e.g., genetic testing) directly to consumers via the Internet increases demand for laboratory services.
Increasing patient cost-sharing creates consumer need and demand for trusted, readily available information to support informed choices.
Drivers for Change
Consumers who express greater desire for ownership of their health care information (including laboratory test results).
Increasing availability of health information on the Internet and
News media attention to personal health issues such as patient safety risks and medical errors enhances consumer interest in understanding, directing, and managing their health care
Value of Laboratorians
Laboratorians can support (aLaboratorians can support (at the patient level)::– communication and partnership
between patients/consumers and health care providers,
– patient/consumer education,– patient/consumer self management of
chronic conditions, and – the needs of special patient
populations.
Needs/Gaps
Patients/consumers must comprehend or be able to utilize laboratory information in both the preanalytic and postanalytic phases of the testing cycle.
Preanalytic communications: consumers need information about:– why a particular test is being ordered,– how the test is performed, and – what the risks are.
Needs/Gaps Postanalytic communications for
patients:– Discussion about laboratory test results
that should clarify what the results mean for patients’ health and medical care.
– Despite the benefits of such communications, few patient-provider interactions meet criteria for completeness in informed decision making.
Needs/Gaps
Inadequate consumer-centric information to help communication between providers and patients is a major contributor to the gap in patients’ knowledge, awareness, and understanding of their health care and health status.
Needs/Gaps
Large discrepancies often exist between the level at which the materials are written and patients’ functional literacy levels.
Future Value
Laboratorians will work with health care providers and patients to develop:– a patient/consumer-friendly, standardized
nomenclature and summary format for laboratory results that
facilitates understanding of important information about screening, diagnostic, and monitoring tests.
Future Value
Laboratorians can design educational materials that will improve patients’ understanding of their health conditions
Lab Tests Online great example
A Different Future?
Several trends increase the value of laboratorians– the continued proliferation of new, complex
laboratory tests; – greater emphasis on patient safety in medical
practice; – inadequate medical education on laboratory
testing despite its growing importance in clinical care; and
– the variable quality of “curbside” consultations with pathologists.
PressuresPressures
Information access – amount, Information access – amount, quality, immediacyquality, immediacy
Service sitesService sites– Moving from traditional settings for Moving from traditional settings for
both public and individual health both public and individual health systemssystems
– Pose major coordination challenges Pose major coordination challenges
Other InitiativesOther Initiatives
Development of evidence-based Development of evidence-based methods to identify and evaluate methods to identify and evaluate Best Practices in Laboratory Best Practices in Laboratory Medicine.Medicine.http://wwwn.cdc.gov/dls/bestpractices/LabBestPractice.pdf
Other InitiativesOther Initiatives
Network of laboratories and Network of laboratories and partnerships with key stakeholders partnerships with key stakeholders in laboratory medicine to support in laboratory medicine to support identification and foster adoption of identification and foster adoption of evidence-based Best Practices.evidence-based Best Practices. To learn more about participating in To learn more about participating in
the pilot test network, click here: the pilot test network, click here: http://wwwn.cdc.gov/dls/bestpractices/participation.aspx
Rituals Of A ProfessionalRituals Of A Professional
What they do for a living defines who What they do for a living defines who they arethey are
Associate with colleagues to affirm Associate with colleagues to affirm themselvesthemselves
Get new ideas, new energy, re-creation, re-Get new ideas, new energy, re-creation, re-newal of selfnewal of self
Reason for attending annual meeting of the Reason for attending annual meeting of the professionprofession
Develop and adhere to an ethical codeDevelop and adhere to an ethical code From Beginning to End - The Rituals of Our LivesFrom Beginning to End - The Rituals of Our Lives
Excellence In Excellence In PerformancePerformance Research on elite performersResearch on elite performers The biggest difference between them The biggest difference between them
and lesser performers is the cumulative and lesser performers is the cumulative amount of practice they’ve hadamount of practice they’ve had– The most important talent was the talent The most important talent was the talent
for practicefor practice– Top performers dislike practice as much as Top performers dislike practice as much as
othersothers But they have the willingness to keep at it But they have the willingness to keep at it
anywayanyway From From Complications Complications by Atul Gawandeby Atul Gawande
ProfessionsProfessions
Their own languageTheir own language A recognized body of knowledgeA recognized body of knowledge Insulated from the rest of the Insulated from the rest of the
world by the work experiences world by the work experiences and the mandatory and the mandatory responsibilitiesresponsibilities– Only fellow professionals know what Only fellow professionals know what
it is really like to do what you doit is really like to do what you do
Professional GatheringsProfessional Gatherings
Where new and better can be foundWhere new and better can be found– Almost an obligation to attendAlmost an obligation to attend
Where there is a place full of people Where there is a place full of people who know what it is really like to do who know what it is really like to do what you dowhat you do
Sense of belongingSense of belonging For the length of the meeting, “our For the length of the meeting, “our
own nation” existsown nation” exists From Complications by Atul GawandeFrom Complications by Atul Gawande
What Are We Doing?What Are We Doing?
Two stone cutters were cutting Two stone cutters were cutting stone for the building of a great stone for the building of a great cathedral. Sir Christopher Wren cathedral. Sir Christopher Wren asked them what they were asked them what they were doing. One stone cutter said: “I doing. One stone cutter said: “I am cutting stone”. The other am cutting stone”. The other answered: “I am building a answered: “I am building a cathedral”.cathedral”.