CHARLOTTE, North Carolina– The main goal of the Institute for Quality in Laboratory Medicine (IQLM) is to “advance health by improving lab services,“ according to Julie Taylor, PhD, senior service fellow in the Division of Public Health Partnerships of Laboratory Services at the Centers for Disease Control and Prevention.
Speaking at CLMA 's (Wayne, Pennsylvania) ThinkLab conference yesterday at the Charlotte Convention Center, Taylor said that IQLM sets standards accepted by a cross-section of players in the healthcare community for laboratories to follow and with the intent to establish processes for operation and accountability that lead to a reduction in errors.
IQLM was incorporated in 2005 after stakeholders in the organization decided that it should be independent of government – or any other body.
“It is not set up to be a regulatory agency,“ Taylor told the audience of about 200, noting that IQLM wants to be a “partnership group,“ and also to do support research, rather than being an accrediting body.
The goal is to generate quality indicators, monitor the progress of labs and develop national reports on how well labs are doing. He said IQLM's focus is to help the laboratory community do this for itself, building its own accountabilities, rather than having some other body do it for them.
Also speaking during Monday's panel was Lee Hil-borne, MD, deputy director, global health, of the Rand Corp. (Santa Monica, California). Hilborne, who chairs the 2006 IQLM Indicators Workgroup, discussed the importance of indicators used to monitor care processes and outcomes, saying that good indicator performance “suggests – but doesn't necessarily mean – good practices.“ And he advised labs to look to good performers for best practices to decrease the potential for patient harm.
“The focus is on improving quality for high priority areas, not to demonstrate one can do well on the indicator,“ Hilborne said, with patient care foremost. Quality indicator characteristics should be “broad and defensible“ and focus on “improving health,“ he said.
Hilborne said the workgroup is determining how to prioritize indicator efforts by considering such things as what is important, where the focus should be, questioning in what testing venues the indicators would be applicable – all without “biting off too much.“
He also referred to an Institute of Medicine (IOM; Washington) report, released earlier this year, introducing a series of performance measurements and information on quality improvement organizations that operate under the auspices of CMS. “The insight that came from that report was really quite good,“ he said, noting that it “parallels“ IQLM's effort.
Any IQLM efforts need to link to the American Healthcare Research and Quality (AHRQ; Washington), they need to define the scope of analysis, the information developed needs to be actionable, data efforts need to be doable in terms of practicality, feasibility and affordability, and submissions toward the report should be audited, Hilborne said.
The indicators also must be sensitive to a variety of different testing venues from hospital laboratories to physician office laboratories to public health labs. And he said that while all phases of the testing process are important, emphasis should be placed on the pre-analytic and post-analytic phases to build relationships with the nurses and physicians who generally order lab tests.
Hilborne noted that while it's easy for an orthopedic surgeon to measure the outcome of a hip replacement procedure, it's much trickier for the laboratory. “Where we play the biggest role is providing information for the subsequent provision of care,“ he said.
And while other bodies ranging from the College of American Pathologists (Northfield, Illinois) to CMS to the Joint Commission on Accreditation of Health Care Organizations (JCHAHO; Oakbrook Terrace, Illinois) all are either working on or have developed quality standards, Hilborne said IQLM's advantage is the involvement of “non-laboratory stakeholders.“ These include accrediting organizations, patients and the public, payers and purchasers and representatives of the diagnostic industry, among others.
The final speaker on the panel, Julie Gayken, director of laboratory services at Regions Hospital (St. Paul, Minn-esota), said that future best-practice sharing would come from such measures as the Patient Safety and Quality Improvement Act of 2005.
Gayken said it creates efforts such as HHS-certified patient safety organizations to facilitate sharing of patient safety activities.
She also noted that there are other efforts to monitor safety. For example, in Minnesota, which is her home state, she said it had the “adverse event law,“ which monitors such events in patient care.
In a Q&A following the presentations, virtually every hand in the room was raised when asked if they preferred a structured way to monitor laboratory processes and safety.