医者の診療所の実験室の結果は,他の実験室で得られた結果と同等の品質ですか?
J Hurst1, K Nickel, L H Hilborne
1Laboratory Field Services, California Department of Health Services, Berkeley, USA.
JAMA
|February 18, 1998
まとめ
医者の診療所の実験室 (POLs) は,他の臨床実験室と比較して,熟練度試験の失敗率が著しく高いことを示しています. これは,POLテストの正確性と信頼性に関する潜在的な問題を示唆しており,さらなる調査と監督が必要である.
科学分野:
- 臨床研究室科学科 臨床研究室科学科
- 医療の質の向上 医療の質の向上
- 医療診断 医療診断
背景:
- カリフォルニア州は,1995年に臨床実験室改善修正案 (CLIA) 基準に適合する実験室法が採択された後,医師の診療所の実験室 (POLs) の実験室結果を他の環境と比較する研究を命じた.
- この研究は,POLで実施されたテストの正確性と信頼性を評価することを目的とした.
研究 の 目的:
- POLの設定で,非POLの設定と比べて,正確で信頼性の高いテスト結果が得られるかどうかを判断する.
- 試験場による実験室試験の質の潜在的格差を特定する.
主な方法:
- 1996年のアメリカバイオアナリスト協会の熟練度テストプログラムからの熟練度テストデータを用いて,臨床実験室の調査が行われました.
- データには,プログラムに参加したカリフォルニア州の全1110の臨床研究室が含まれていました.
- 測定された結果は,熟練度テストのサンプルで"不満足" (一度の失敗) と"失敗" (繰り返し失敗) の割合でした.
主要な成果:
- 医師事務所の研究室 (POLs) は,非POLs (21.5%対8.1%) よりもほぼ3倍高い"不満足"の失敗率を示しました.
- POLの"失敗した"失敗率は,非POLの4倍以上 (4.4%対0.9%) でした.
- 実験室の専門家を利用したPOLは,非POLと比較して,失敗率が低いが,それでもかなり高いことを示しました.
結論:
- POL,ライセンスプロフェッショナルを持つPOL,およびPOLでないPOLの間には,重要な品質の違いが存在します.
- 多くのPOLのテストスタッフには,適切な教育,訓練,監督が欠けていて,パフォーマンスの低下に寄与する可能性があります.
- POLの性能の低下の原因となる要因を理解するためにさらなる研究が必要であり,患者は検査の質の潜在的変動を認識する必要があります.
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