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Changes in Test Volumes During Coronavirus Disease 2019 (COVID-19): A Laboratory Stewardship Opportunity
Ila R Singh1, Michael Dowlin1, Thomas H Chong1
1From the Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston (Singh, Dowlin, Chong).
Insights
The COVID-19 pandemic caused significant disruptions in laboratory testing, particularly for chronic disease management. Laboratory stewardship programs are crucial for addressing these care gaps and ensuring equitable patient care.
Area of Science:
- Medical Laboratory Science
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic significantly altered healthcare delivery, leading to deferred non-urgent care and potential adverse patient outcomes.
- Understanding the impact on laboratory services is crucial for identifying and mitigating care gaps.
Purpose of the Study:
- To identify opportunities for laboratory test stewardship to address care gaps exacerbated by the COVID-19 pandemic.
- To analyze trends in laboratory test volumes before and during the pandemic.
Main Methods:
- Retrospective time series analysis of laboratory service data.
- Examination of testing patterns within a large metropolitan health system serving women and children.
- Comparison of pre-pandemic and pandemic-era laboratory test volumes.
Main Results:
- Laboratory test volumes showed varied patterns: immediate decline with recovery, no change, or persistent decrease.
- Tests for chronic illness diagnosis and monitoring, such as hemoglobin A1c and blood lead levels, experienced significant initial declines and incomplete recovery.
- Persistent decreases were observed in specific diagnostic and monitoring tests, highlighting potential ongoing care deficits.
Conclusions:
- The pandemic has negatively impacted patients, practitioners, and health systems, with laboratory data revealing critical gaps in care.
- Underuse of laboratory tests, especially for chronic disease management and underserved populations, poses a significant threat.
- Laboratory stewardship programs focused on peri-pandemic care can position laboratory professionals as leaders in promoting appropriate, equitable, and efficient healthcare.
Context.—:
Coronavirus disease 2019 (COVID-19) changed the dynamics of health care delivery, shifting patient priorities and deferring care perceived as less urgent. Delayed or eliminated care may place patients at risk for adverse outcomes.
Objective.—:
To identify opportunities for laboratory test stewardship to close potential gaps in care created by the COVID-19 pandemic.
Design.—:
The study was a retrospective time series design examining laboratory services received before and during the COVID-19 pandemic at a large metropolitan health system serving women and children.
Results.—:
Laboratory test volumes displayed 3 distinct patterns: (1) a decrease during state lockdown, followed by near-complete or complete recovery; (2) no change; and (3) a persistent decrease. Tests that diagnose or monitor chronic illness recovered only partially. For example, hemoglobin A1c initially declined 80% (from 2232 for April 2019 to 452 for April 2020), and there was a sustained 16% drop (28-day daily average 117 at August 30, 2019, to 98 at August 30, 2020) 4 months later. Blood lead dropped 39% (from 2158 for April 2019 to 1314 for April 2020) and remained 23% lower after 4 months.
Conclusions.—:
The pandemic has taken a toll on patients, practitioners, and health systems. Laboratory professionals have access to data that can provide insight into clinical practice and identify pandemic-related gaps in care. During the pandemic, the biggest patient threat is underuse, particularly among tests to manage chronic diseases and for traditionally underserved communities and people of color. A laboratory stewardship program, focused on peri-pandemic care, positions pathologists and other laboratory professionals as health care leaders with a commitment to appropriate, equitable, and efficient care.
