Laboratory Stewardship: The missing piece of care your practice can’t ignore

Laboratory testing is the backbone of many clinical decisions. Laboratory stewardship helps ensure testing is used for the right patients when it is truly needed.

Laboratory testing is the single highest volume medical activity in the United States, with somewhere in the range of 4-5 billion tests performed each year nationwide. Too often, a possibly inappropriate test is selected, a redundant test is ordered, or a needed test is omitted, creating gaps in patient care and decreasing the quality of care.

In recent years, many health systems and hospitals have begun to implement “test utilization” or “laboratory stewardship” programs to identify patterns in lab ordering and thereby close gaps in care. These programs aim to make use of laboratory data to guide healthcare decisions, both for the individual patient and at a population level.

Yet, many healthcare providers lack data management systems that enable nimble and effective use of laboratory data. Independent physician practices may be especially hard stretched to devote staff or technologies to managing laboratory data to transform into actionable insights. Failure to manage laboratory utilization can impact not only patient care but also the ability to meet various quality metrics on which payments may be based under fee-for-value programs.

To address these hurdles, some laboratories and laboratory professionals have introduced services to help their colleagues improve the management of their laboratory utilization. Quest Diagnostics, the national laboratory provider, introduced a lab stewardship service with hc1® in 2019. The service uses automated technologies to layer over existing technologies to track lab utilization patterns relative to medical guidelines and other customized parameters.

Although laboratory stewardship programs serve many purposes, a key quality component is helping to prevent gaps from forming and to provide high-quality care to patients. But while this is the core goal of what laboratory stewardship aims to provide, that is not all that it is. A lab stewardship program, particularly at the health-system level, goes beyond basic reporting and empowers physicians, laboratorians, lab administrators, and medical leadership with real-time, actionable insights to help drive targeted test utilization improvements, lab operations and patient outcomes. The insights provided can help labs run more efficiently by organizing data, providing monitoring in real time and improving patient care and the physician experience while reducing lab spend.

For instance, during the COVID-19 pandemic, many patients delayed or skipped preventive care. Re-engaging these patients begins with identifying them and their specific risks. As a simple example, an automated lab stewardship program can quickly identify which patients in a practice or system are late for a diabetes screening, based on the date of the most recent HbA1c or fasting glucose test. With this information, the healthcare provider can engage the patient and hopefully persuade them to re-engage in their care.

Fundamentally, an effective lab stewardship program helps advise that the right test is ordered for the right patient at the right time. Obviously, the program isn’t intended to replace the expert judgment of a healthcare provider, but it can provide feedback about recommended practices and situations where tests may have already been performed and repeat testing may not be as critical. Providing this information can improve transparency and patient care, as well as enable a more efficient use of resources. With these insights, laboratory professionals can more easily anticipate needs and help their medical colleagues deliver better care.

With a high-volume of tests performed by many labs nationwide, organizing data is one of the most important aspects to running an efficient practice. But most importantly, we know that gaps in care can result in unfavorable outcomes for patients who, if identified earlier, could have been treated more effectively. A lab stewardship program not only can provide enhanced patient care capabilities but can also help laboratorians visualize population care gaps and consult with medical staff to identify areas of possible concern.

When executed effectively, a laboratory stewardship program empowers providers to deliver on their commitment to assure appropriate, equitable and efficient care.

About the Author
Lee Hilborne, MD, MPH, Senior Corporate Medical Director, Quest Diagnostics