As the mindset of healthcare shifts from volume to value, the percent of outpatient visits will continue to grow. This is largely due to the transition to more effective population health models of care. In these models health systems and physician practices work together to develop initiatives to keep the community healthy. Thus reducing things such as chronic disease and costly hospital stays. With this shift in the market, the performance and quality of patient outcomes in the outpatient setting is a key focus in pay-for-performance models. Accountable care organizations (ACO), the Centers of Medicare and Medicaid Services (CMS) and other organizations such as the National Committee for Quality Assurance (NCQA) are focusing heavily on outpatient performance metrics to gauge the quality of health care being delivered.

This shift to outpatient care, and more integrated, process driven models of care has provided a common ground for the laboratory and other ancillary departments to the overall delivery of care. Many of the quality measures include performance standards around diagnostics testing to ensure patient outcomes are optimized, and clinical standards are applied. This provides a unique opportunity for clinical laboratories to impact not only the quality of care, but how it is delivered. Much of the application of point-of-care testing (POCT) has been centered on speed, and being able to provide patient education. However, POCT has benefits far beyond merely providing a faster result, and when applied correctly can help to improve performance measures. Properly integrating POCT into clinical practice is the key obstacle in leveraging it to improve performance measure scores. The application of 6 core principles can help to transform POCT from just a device and a result, to an integrated care and delivery solution. These principles are standardize, make clinically relevant, enhance accountability, simplify, process improvement, and engage patients. Many labs may shy away from POCT testing due to increase regulatory pressures, but applying these concepts actually helps to more effectively control and standardize the use of POCT.

Standardization is the first step in effectively utilizing POCT in the outpatient setting, many approaches utilized in the past included standardized training and procedures. While effective they lack the ability to integrate the device within the delivery of care. Complementing traditional methods of standardization with a collaborative practice agreement is key for integrating POCT into the delivery of care. These agreements are a fixture in practice management and hospital administration, they help direct privileges, clinical guidelines and practice guidelines. Creating collaborative practice agreements regarding the use of specific POCT equipment in clinical care provides a way to help standardize, and ensure that the device is used as intended. These agreements also hold more weight and sway with clinicians, and help to enhance accountability. These agreements also ensure that the use of POCT is made clinically relevant by establishing set guidelines for treatment, applying the same risk factors, and standardizing patient education across multiple practices. In doing so you help to increase patient’s perceptions surrounding provider communication and shared decision making, which are key performance measures in the outpatient setting.

The laboratory thrives on compliance and accountability, it is paramount in ensuring laboratory results are consistent and of high quality. Accountability is often something laboratories struggle with in their POCT programs. Developing accountability starts with standardization, utilizing a collaborative practice agreement can help to standardize and enhance accountability around qualifications, training, oversight and testing privileges. Providing a singular source to both standardize compliance, and hold individuals accountable to abide by the proper standards. Additionally collaborative practice agreement requirements are a focus in the credentialing process for positions, thus aiding in ensuring qualified personnel are performing and resulting POCT.

The collaborative practice agreement helps to also lay the ground work for the remaining key principles of, simplify, process improvement, and engage the patient. These principles will have the most impact on outpatient performance measures. The principles of simplifying and process improvement may seem as if they are one in the same, but each takes a different perspective when aiming to improve performance measures. With simplifying how we utilize POCT, we are looking from the patient’s perspective. Developing a process that is simple for the patient increases the likelihood of patient compliance, and patient compliance is a key factor to improving performance measures. A key factor in simplifying the process for the patient is the location in which testing is being performed. Many labs and practices will use point-of-care devices in the most obvious location, the physician office or exam room. While this is an obvious point-of-care, there are many others such as the pharmacy, nurse triage, patient education and support departments and the list goes on. These non-traditional locations may be the optimal point in the clinical flow to utilize a point-of-care device. Often times the failure of a POCT device to have its desired effect is not so much the device itself, but where it is located. Poorly placed point-of-care devices can often result in issues with compliance, and patient satisfaction.

In the outpatient setting ensuring the location of POCT is optimized for the patient, and not just the clinician is key to the overall success of the device. While the principal of simplifying the process for the patient helps to identify locations for POCT, the principle of process improvement helps to determine which proposed location is optimal. In looking to improve performance measures surrounding diabetes management, a lab may identify three locations to potentially utilize a point-of-care Hb A1c device such as the exam room, pharmacy and diabetes education. Understanding the principles of process improvement such as gathering baseline compliance data, desired benchmarks, and performing pilot studies is vital to determine which of the three locations yields the most benefit. Essentially aligning with the mindset that healthcare is shifting from volume to value. Continuing with the concept of process improvement we pull in the remaining principle of engaging the patient. Your development of the patient flow and location of POCT has an impact on patient engagement. Just as we examine compliance and benchmark data, we also need to gauge patient satisfaction. Including patient surveys, and even shadowing patients to gain feedback on the proposed locations and patient flow can help to ensure that your utilization of the point-of-care device optimizes patient engagement. Looking again at Hb A1c our pilot data may tell us that both the pharmacy and diabetes education have the best compliance rates for patients, however the patient satisfaction scores for the pharmacy are significantly higher.

This would lead us to determine that we would gain the most benefit in both compliance, and patient engagement by utilizing the pharmacy based model. Each of the key principles when applied help to build upon the overall aim of engaging the patient through the use of POCT. An engaged patient not only has better compliance and satisfaction with their care, but also has better health outcomes. This is the overall purpose of performance measures, to ensure that health care organizations are focusing and performing well in those areas that can substantially impact the community’s health and patient outcomes. This is the bigger picture that the majority of clinical laboratories across the country have not been previously involved with. As the industry shifts to the pay-for-performance model all specialties and areas of health care are going to have to come to the plate with solutions to impact performance. By applying the key principles discussed the laboratory can leverage point-of-care testing to substantially impact key performance measures, and patient outcomes.

None.

The author declares no conflict of interest.