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Improvement in physician's office laboratory practices, 1989-1994.

T M St John1, H B Lipman, J M Krolak

  • 1Centers for Disease Control and Prevention, Public Health Practice Program Office, Division of Laboratory Systems, Atlanta, GA, USA. tmstjohn@mmmincorp.com

Archives of Pathology & Laboratory Medicine
|July 11, 2000
PubMed
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Physician office laboratory quality improved significantly after the Clinical Laboratory Improvement Amendments of 1988 (CLIA

Area of Science:

  • Clinical Laboratory Medicine
  • Healthcare Quality Improvement
  • Public Health Surveillance

Background:

  • Physician office laboratories (POLs) emerged as significant sites for clinical laboratory testing.
  • Limited data existed on POL practices before 1992.
  • The Centers for Disease Control and Prevention initiated data collection via the National Ambulatory Medical Care Survey.

Purpose of the Study:

  • To assess clinical laboratory practice in POLs from 1989-1994.
  • To evaluate the impact of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) final rule on POL quality.
  • To identify factors associated with quality laboratory practices in POLs.

Main Methods:

  • National probability sample of office-based physicians providing ambulatory care.

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  • Data collected through surveys in 1989, 1991, 1993, and 1994.
  • Weighted analyses compared practices before and after CLIA '88 final rule implementation in 1992.

    • Main Results:

    • Significant improvements in quality indicators observed post-CLIA '88 final rule.
    • Increased enrollment in proficiency testing (32.4% to 52.7%) and daily quality control (79.2% to 89.0%).
    • Presence of trained laboratory professionals was linked to higher quality practices.

    Conclusions:

    • CLIA '88 final rule and trained staff are crucial for improving POL quality.
    • Minimum practice standards and professional expertise enhance laboratory quality.
    • Overall testing volume remained stable despite a decrease in on-site testing locations.