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Through the combined efforts of the American Pathology Foundation (APF), the American Society for Clinical Pathology (ASCP), and the Program Directors Section (PRODS) of the Association of Pathology Chairs (APC), a needs assessment was performed via a survey on the PRODS listserv, workshops at the APC/PRODS annual meetings in 2009 and 2010, and a Work Group of representatives of APF, ASCP, and PRODS. Residency program needs and resource constraints common to training pathology residents in practice and laboratory management were identified. In addition, a consensus curriculum for management training was created to serve as a resource for residency training program directors and others. The curriculum was converted into a "wiki" design tool for use by program directors, residents, and faculty.

Κατά τα τελευταία έτη παρατηρείται μια ραγδαία αύξηση του ενδιαφέροντος, από μια μεγάλη γκάμα κοινωνικών ομάδων (φαρμακευτικές εταιρίες, ιδιώτες κτλ), αλλά και το κράτος, για την οικονομική αποτίμηση των ιατρικών πράξεων. Ο χώρος της ακτινολογίας ιδιαίτερα, παρουσιάζει στην Ελλάδα μια ιδιαίτερη δυναμική και αυξανόμενους ρυθμούς, γι’ αυτό το λόγο πέρα από την καθαρά ιατρική επισκόπηση των εξελίξεων της επιστήμης, απαιτείται και μια επιστημονικά έγκυρη οικονομική αποτίμηση και αξιολόγηση. Η παρούσα διατριβή έρχεται να καλύψει το κενό αυτό που υπάρχει στον χώρο της υγείας, ή ακριβέστερα στην επιτομή της Ιατρικής και Οικονομικής Επιστήμης για την εξαγωγή γόνιμων συμπερασμάτων που αφορούν την ορθολογική αξιολόγηση των περιορισμένων πόρων της Υγείας. Το πρώτο μέρος της εργασίας, που αποτελείται από τα 4 πρώτα κεφάλαια, αναφέρεται στο καθαρά ιατρικό μέρος που αφορά την ακτινολογία στις μέρες μας. Στο δεύτερο μέρος η μεθοδολογία και το ύφος αλλάζουν, προκειμένου να καλυφθεί αυτή η δεύτερη αναγκαιότητα για την οποία έγινε λόγος παραπάνω. Ευελπιστώ ότι η παρούσα διατριβή θα αποτελέσει την απαρχή και άλλων τέτοιων προσπαθειών, δεδομένης της σχεδόν ανύπαρκτης παιδείας των Ιατρών στην Οικονομική επιστήμη και στις συχνά ενδιαφέρουσες και γοητευτικές - αν και ενίοτε δυσνόητες- μεθόδους της. / -

O trabalho tem como objetivo avaliar a eficácia do processo de implantação de um programa de acreditação laboratorial através de indicadores. O uso dos indicadores vem sendo cada vez mais valorizado na gestão laboratorial por tratar-se de uma poderosa ferramenta para qualificar e quantificar falhas nos diferentes processos laboratoriais, bem como, auxiliar na implantação de medidas preventivas e corretivas, além de apontar a eficácia das ações tomadas. Nesse contexto, foi utilizado o modelo do Programa de Acreditação de Laboratórios Clínicos da Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (PALC SBPC/ML), o qual foi aplicado no Laboratório Unimed de Sorocaba. O ano de 2008 foi o ponto inicial para adequação do laboratório aos requisitos do PALC. Foram definidos 25 indicadores, sendo 14 focados aos aspectos gerenciais e 11 relacionados ao processo produtivo. Um grupo formado por 19 indicadores pôde ser comparado aos adotados pelo Programa de Indicadores Laboratoriais da SBPC/ML-ControlLab. A coleta de dados corresponde ao período entre 2006 e 2011. Para os indicadores avaliados pelo Programa de Indicadores Laboratoriais da SBPC/ML-ControlLab estabeleceu-se como meta a ser alcançada pelo Laboratório Unimed Sorocaba a mediana dos resultados obtidos pelos laboratórios participantes do programa. A análise estatística revelou que 10 indicadores apresentaram resultados satisfatórios e 4 Keila Furtado Vieira demonstraram piora. Outros 4 não apresentaram mudanças significativas e 7 não foram passíveis de análise estatística. Para os indicadores que se mostraram deficientes foram traçados planos de ação visando elevar a eficiência das respectivas atividades. A melhora dos indicadores refletiu as reestruturações de processo ocorridas para adequação à norma de acreditação escolhida / The aim of the present study was to evaluate the efficacy of implementation of a laboratory certification program by using laboratory quality indicators. The use of such indicators has been increasingly valued in laboratory management because it is a powerful tool to quantitatively and qualitatively measure mistakes in laboratory process, as well as in implementation of corrective and preventive measures and to identify the efficacy of the actions taken. The Clinical Laboratories Accreditation Program of the Brazilian Society of Clinical Pathology/Laboratory Medicine was applied in the UNIMED Sorocaba Clinical Laboratory (São Paulo, Brazil). Implementation of the requirements for certification started in 2008. Twenty four indicators were defined, 14 of those focused on management aspects and 11 focused on production aspects. A group composed of 19 indicators could be compared to those adopted by the Brazilian Society of Clinical Pathology/Laboratory Medicine and ControlLab named Laboratory Indicators Program. Data collection and analysis were performed between 2006 and 2011. The goal was to reach the median of the results established by the Laboratory Indicators Program. Statistical analysis revealed that 10 indicators presented satisfactory results, whereas 4 showed a worsened outcome. Four indicators did not change and 7 indicators could not be used for statistical analysis. Action planning was designed for the indicators below the acceptable levels Keila Furtado Vieira in order to improve the efficiency in those activities. Improvement of these indicators reflected the implementation of processes to adequate it to the guidelines of the certification program

O trabalho tem como objetivo avaliar a eficácia do processo de implantação de um programa de acreditação laboratorial através de indicadores. O uso dos indicadores vem sendo cada vez mais valorizado na gestão laboratorial por tratar-se de uma poderosa ferramenta para qualificar e quantificar falhas nos diferentes processos laboratoriais, bem como, auxiliar na implantação de medidas preventivas e corretivas, além de apontar a eficácia das ações tomadas. Nesse contexto, foi utilizado o modelo do Programa de Acreditação de Laboratórios Clínicos da Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (PALC SBPC/ML), o qual foi aplicado no Laboratório Unimed de Sorocaba. O ano de 2008 foi o ponto inicial para adequação do laboratório aos requisitos do PALC. Foram definidos 25 indicadores, sendo 14 focados aos aspectos gerenciais e 11 relacionados ao processo produtivo. Um grupo formado por 19 indicadores pôde ser comparado aos adotados pelo Programa de Indicadores Laboratoriais da SBPC/ML-ControlLab. A coleta de dados corresponde ao período entre 2006 e 2011. Para os indicadores avaliados pelo Programa de Indicadores Laboratoriais da SBPC/ML-ControlLab estabeleceu-se como meta a ser alcançada pelo Laboratório Unimed Sorocaba a mediana dos resultados obtidos pelos laboratórios participantes do programa. A análise estatística revelou que 10 indicadores apresentaram resultados satisfatórios e 4 Keila Furtado Vieira demonstraram piora. Outros 4 não apresentaram mudanças significativas e 7 não foram passíveis de análise estatística. Para os indicadores que se mostraram deficientes foram traçados planos de ação visando elevar a eficiência das respectivas atividades. A melhora dos indicadores refletiu as reestruturações de processo ocorridas para adequação à norma de acreditação escolhida / The aim of the present study was to evaluate the efficacy of implementation of a laboratory certification program by using laboratory quality indicators. The use of such indicators has been increasingly valued in laboratory management because it is a powerful tool to quantitatively and qualitatively measure mistakes in laboratory process, as well as in implementation of corrective and preventive measures and to identify the efficacy of the actions taken. The Clinical Laboratories Accreditation Program of the Brazilian Society of Clinical Pathology/Laboratory Medicine was applied in the UNIMED Sorocaba Clinical Laboratory (São Paulo, Brazil). Implementation of the requirements for certification started in 2008. Twenty four indicators were defined, 14 of those focused on management aspects and 11 focused on production aspects. A group composed of 19 indicators could be compared to those adopted by the Brazilian Society of Clinical Pathology/Laboratory Medicine and ControlLab named Laboratory Indicators Program. Data collection and analysis were performed between 2006 and 2011. The goal was to reach the median of the results established by the Laboratory Indicators Program. Statistical analysis revealed that 10 indicators presented satisfactory results, whereas 4 showed a worsened outcome. Four indicators did not change and 7 indicators could not be used for statistical analysis. Action planning was designed for the indicators below the acceptable levels Keila Furtado Vieira in order to improve the efficiency in those activities. Improvement of these indicators reflected the implementation of processes to adequate it to the guidelines of the certification program

Laboratory analyses, essential in screening, diagnosis, treatment, and monitoring of disease, are indispensable in health care, but appropriate utilization is intricate. The overall aim of this thesis was to study the use of laboratory tests in Sweden with the objective to evaluate and optimize test utilization. Considerable inter-county variations in test utilization in primary health care in Sweden were found; variations likely influenced by local traditions and habits of test ordering leading to over- as well as underutilization. Optimized test utilization was demonstrated to convey improved quality and substantial cost savings. It was further established that continuing medical education is a suitable means of optimizing test utilization, and consequently enhancing quality and cost-efficiency, as such education was demonstrated to achieve long-lasting improvements in the test ordering habits of primary health care physicians. Laboratory tests are closely associated with other, greater, health care costs, but their indirect effects on other areas of medicine are rarely evaluated or measured in monetary terms. In an illustrative example of the effects that optimal test utilization may have on associated health care costs it was demonstrated that F-calprotectin, a fecal marker of intestinal inflammation, has the potential to substantially reduce the number of invasive investigations necessary in, and the costs associated with, the diagnosis of Inflammatory Bowel Disease. Information on trends in test utilization is essential to optimal financial management of laboratories. A longitudinal evaluation revealed that test utilization had increased by 70% in 6 years, and even though the selection of tests more than doubled, a very small number of tests represented a stable, and disproportionally large, share of the total number of tests ordered. The study defines trends and thus has potential predictive values. In summary, appropriate utilization of laboratory analyses has both clinical and economical benefits on all levels of health care.

The purpose of this study was to develop a laboratory based Comprehensive Care, Management and Treatment of HIV and AIDS (CCMT) programme status reporting system using a methodological research study design. Quantitative data was collected using a request form and qualitative data was collected using structured questionnaires. For the study 1190 eligible CD4 samples were received, of which 1004 (84%) had a valid CCMT programme status. Overall 32% of the CD4 samples had a pre-ART status (n=383) and 52% had an ART status (n=621). The remaining 16% of CD4 samples (n=186) did not have a valid CCMT programme status. A pre-ART register was generated and assessed using a structured questionnaire. Based on the study findings a recommendation has been made to adopt the two-tick design for all NHLS request forms where programmatic data is collected. Additionally the CCMT programme status reporting system is recommended for rollout to other health districts / Health Studies / M.A. (Public Health with specialisation in Medical Informatics)

The purpose of this study was to develop a laboratory based Comprehensive Care, Management and Treatment of HIV and AIDS (CCMT) programme status reporting system using a methodological research study design. Quantitative data was collected using a request form and qualitative data was collected using structured questionnaires. For the study 1190 eligible CD4 samples were received, of which 1004 (84%) had a valid CCMT programme status. Overall 32% of the CD4 samples had a pre-ART status (n=383) and 52% had an ART status (n=621). The remaining 16% of CD4 samples (n=186) did not have a valid CCMT programme status. A pre-ART register was generated and assessed using a structured questionnaire. Based on the study findings a recommendation has been made to adopt the two-tick design for all NHLS request forms where programmatic data is collected. Additionally the CCMT programme status reporting system is recommended for rollout to other health districts / Health Studies / M.A. (Public Health with specialisation in Medical Informatics)