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Continuous Quality improvement

High Quality laboratory results are generated when all phases of the measurement process are

conducted properly.

Factors which promote high quality results include:

1) Competent, well-trained and motivated laboratory staff.

2) Quality laboratory facilities.

3) Well-maintained, high-quality laboratory equipment.

4) High quality laboratory methods.

5) Clear commitment of management to quality laboratory results.

Quality Assurance:

The goal of quality assurance is to monitor and evaluate the overall quality of the testing process

including pre-analytic, analytic and post analytic phases.

The basic mechanism for QA is the quality audit , quality audits should be conducted by the

Lab , the results should be documented including remedial actions taken to address

conditions that merit correction.

Quality Audit: Patient test management

The quality audit for patient test management shall be conducted at least yearly and consist of:

1) A survey of the technical supervisors of the procedures used in the lab, the survey should

include requests for information on:

– Any changes which need to be made in patient preparation, specimen collection, labeling ,

preservation and transportation.

– Any changes which need to be made in completeness and relevance of patient information

obtained at the time , the specimen is required, and the use and appropriateness of specimen

rejection criteria based on their experience and interactions with persons requesting the tests.

-Laboratory reporting errors encountered since last survey.

-Non-Trivial problems in communication with persons requesting patient tests.

-Non -Trivial complaints from outside the laboratory about performance of the lab.

2) A random sampling of test reports issued since the last audit to evaluate:

whether data was released in a timely manner, whether the report was legible, whether the

report was in proper format ( including reference ranges, units of measure, matrix of

measurement, notation for inadequate specimen , sent only to the authorized individual

requesting the results )

Quality Audit: Quality Control.

Quality control address the analytical phase of measurement.

QC materials are used to assure quality of the analytical phase.

the purpose of the quality audit of the QC is to assure the QC analyses were performed and

appropriate actions taken when out of control conditions occurred.

the quality audit of quality control shall be conducted at least yearly and should consist of:

1- A review of QC for a random sampling of procedures covering a period of not less than one

year, the review evaluates whether appropriate corrective action was performed and

documented out-of-control conditions.

2-A review of the procedures used to establish the reference range for a sampling of procedures,

assuring that problems were satisfactorily resolved.

3) A review of the proficiency testing results of procedures for not less than one year.

The review will assess whether unacceptable performance on PT has been adequately corrected.

4) If applicable , a review of procedure which are performed by two different methods or two

different instruments or at two different sites, the review shall document that at least once every

six months a set of at least five sample spanning the re portable range are run on both

instruments, if The re portable range differs on two instruments, they should be compared in

concentration range that is included in the re portable range of each instrument.

Quality Audit: Personnel

Well trained and competent personnel are essential for good laboratory performance, the quality

audit personnel shall be conducted at least yearly and should consist of an audit the

documentation of personnel training and evaluation to check whether testing personnel have

been evaluated in the last year , the laboratory must document the results of the audit.

Quality assurance review with staff:

The director reviews pertinent quality audit information with appropriate staff to assure

effective remedial actions are taken, staff who have been involved in the audit are also notified

by branch chief if performance was acceptable and no remedial is needed.

The American Healthcare System

Introduction

The American healthcare system is one of the most advanced yet costly health systems in the world. Whereas the united states provides cutting edge technologies and innovative solutions to other countries , it seems incompetent when it comes to more urgent and pressing issues in homeland.

In the following context , we are going to discover this unique healthcare system, starting by its components , and cost drivers , ending with the future projections.

The American health care components:

The American health care system is made up of three interrelated components:

1- health care consumers;

2- health care providers; and

3- the institutions or organizations of the health care system.

The institutional component includes hospitals, clinics, and home-health agencies; the insurance companies and programs that pay for services like Blue Cross/Blue Shield, managed-care plans such as health maintenance organizations (HMOs), and preferred provider organizations (PPOs); and entitlement programs like Medicare and Medicaid (federal and state government public assistance programs). ¹

Financing the US healthcare system:

Financing the US healthcare system can be broken down into three categories ,

1- Payments paid by the public sector, i.e. the federal government, state and local governments.

2- The private sector ( private insurance companies and businesses ).

3- The consumer himself , by out of the pocket expenses.

Many of these payers have other capacities and exert substantial influence in other area of the healthcare system , through policy making (e.g., CMS ) or through advocacy groups and lobbying (e.g., private insurance companies )

Outcomes and Performance:

In order to see how the American healthcare system is doing , we have to compare with other health systems , basically in OECD countries.

The US is the only industrialized country that does not provide universal healthcare benefits to its citizens , Whereas infant mortality has steadily declined in industrialized world countries , the US rate for infant mortality has climbed above that of the OECD mean .

In addition to the life expectancy rate which falls behind the OECD countries average.

The US spends significantly more than other industrialized nations on health care , both as a percentage of GDP and per capita , Unfortunately this spending does not translate into outcomes, this suggest that there are significant insufficiencies in the US healthcare system and that the value of the services in the US healthcare system maybe lower compared with that in the other OECD countries .

Access to healthcare in the united states can significantly increase the beneficial effects and primary and preventive care by reducing the uninsured population, This can prevent the expensive complications of chronic conditions , improving the outcomes for all, This improves quality and creates additional value by way of more equitable access and better outcomes .

Accessing the American healthcare system:

The US government does not offer universal healthcare coverage to its citizens , as a result , a significant portion of the population does not have health insurance, and access to healthcare services , individuals would have to pay out of pocket , this has a primary reason for lack of access to health care , Uninsured individuals that are unable to pay often get the care they need through emergency departments when they are very sick , after the opportunity to avoid preventable conditions has passed.

Unfortunately the uninsured make up a significant and growing percentage of the US population.

Health Insurance coverage for immigrants:

In 1997, 34.3% of non-U.S. citizens living in America did not have health insurance coverage, In each age and income group, immigrants are less likely to have health insurance, With the recent healthcare changes, many legal immigrants with various immigration statuses now are able qualify for affordable health insurance.

Health Insurance for visitors:

Visitors to the U.S. cannot purchase health insurance that is available for U.S. citizens and permanent residents. Most domestic insurance policies purchased overseas cease to be effective inside the U.S., when individuals cross their home country borders during international travel.

References:

1- <a href=”http://www.libraryindex.com/pages/1817/Nation-s-Health-Care-System-COMPONENTS-HEALTH-CARE-SYSTEM.html”>The Nation’s Health Care System – The Components Of The Health Care System</a>

http://www.ustia.org/