Laboratory Medicine and Healthcare Excellence - Till Death do us Part.

The union between laboratory medicine and healthcare excellence is strong, interconnected and has stood the test of time. This partnership is essential in the quest for value-based health care, expanding the strategic role of the clinical laboratory from traditional, transactional models to strategic ones that expedite or activate new cascades of care. This paper reviews outcomes and key trends following global recognition of integrated clinical care teams for exemplary outcomes of measurably better health care. In all cases, laboratory medicine was either a key contributor or leader in predictive risk management, preventative health, and integration of clinical care through active synthesis of relevant data: data that are too often under-used, under-recognized, or even missing in traditional models of care. Outcomes connect multi-disciplinary teams with favorable key performance indicators across patients, payors, clinicians and health systems, as well as top disease burdens and unmet gaps of care. Results affirm the possibilities ahead with proactive engagement across healthcare professionals including the vital and active role of laboratory medicine. With the future upon us, it is incumbent upon all healthcare professionals to work together, learn from others, champion health outcomes and join in a pledge for healthcare excellence.

Effect of population selection on 99th percentile values for a high sensitivity cardiac troponin I and T assays.

OBJECTIVE: Using objective laboratory and clinical criteria to more accurately determine the 99th percentile values for cardiac troponin I and T. DESIGN AND METHODS: We measured cardiac troponin T and cardiac troponin I with high-sensitivity assays in a large cohort of apparently healthy community subjects and calculated 99th percentiles for different sexes and ages. Subjects with possible subclinical disease were eliminated based on objective laboratory criteria, eGFR and NT-proBNP, and clinical criteria, history and examination and echocardiogram. RESULTS: For men and women of all ages, separately, more than 50% of subjects were excluded using these criteria, with a lesser proportion of younger subjects being excluded. In men aged <75 years, the 99th percentile for cTnI decreased by more than 50% from 22.9 ng/L to 10.3 ng/L. In other age groups and for cTnT the decrease was smaller (%) but still considerable. CONCLUSIONS: For establishing cardiac troponin 99th percentiles, simply using self-reporting of health is insufficient. Objective laboratory measures and clinical and echocardiographic assessments are essential to define a healthy population, especially in older persons.

Canadian Laboratory Initiative on Pediatric Reference Interval Database (CALIPER): pediatric reference intervals for an integrated clinical chemistry and immunoassay analyzer, Abbott ARCHITECT ci8200.

OBJECTIVES: A comprehensive set of age- and gender-specific pediatric reference intervals is essential for accurate interpretation of laboratory tests in a pediatric setting. DESIGN AND METHODS: 1459 serum/plasma from children attending select outpatient clinics and deemed to be metabolically stable, were collected from five age groups; 0-12 months, 1-5 years, 6-10 years, 11-14 years and 15-20 years. Samples were analyzed for 24 chemistries and 15 immunoassays on ARCHITECT ci8200. RESULTS: Reference intervals were established according to CLSI/IFCC C28-P3 guidelines by the Robust statistical method. The ranges reflect the central 95% confidence intervals for the population tested. Age and gender were partitioned using the Harris-Boyd method. CONCLUSIONS: While these intervals are ci8200 method specific, they not only provide robust intervals for users of this system but are also useful for any laboratory requiring pediatric intervals if they can be shown to be transferable and if validated for the local patient population.