News Release

Report Focuses On Managed Care Impact In Clinical Microbiology Labs

Peer-Reviewed Publication

American Society for Microbiology

Increasing pressures to use lesser-trained workers in clinical microbiology laboratories and to employ short-cut methods can lead to compromises in the quality of microbiological analysis and detract from optimal patient care unless preventive steps are taken, warns a report issued by the American Academy of Microbiology.

"An inappropriate focus on bottom-line accounting also undervalues the most precious resource of the clinical microbiologist: time," says the report, Clinical Microbiology in the Changing World of Health Care Management. "The primary challenge facing the clinical microbiologist as the 21st century approaches is that of integrating new technologies and molecular-based methodologies with existing methods to provide cost-effective, high-quality microbiology service."

The report is the result of a colloquium held June 27-29, 1997, in Washington, D.C. The colloquium was convened to assess the impact of current and future changes in health care on clinical microbiologists and the practice of clinical microbiology.

"One purpose of this colloquium was to identify the emerging problems that have developed as a result of changes in technology, the economic environment, and biological research," says Dr. Noel R. Rose of Johns Hopkins University Schools of Medicine and Public Health, one of the chairs of the colloquium steering committee and primary author of the report.

"But more importantly, we wanted to try and recommend solutions to these issues before they become intractable problems. Efforts are urgently needed to study and implement methods for addressing the issues we have identified." Changes in health care that affect clinical microbiology are taking place on multiple levels. One of the most important involves the ongoing changes in infectious disease pathogens, patient populations, and clinical presentations of infectious disease. Existing capabilities for diagnosing and managing newly recognized disease processes, including new pathogens, new patterns of drug resistance, and new epidemiological and environmental patterns must be enhanced.

Additionally, the expansion of increasingly susceptible patient groups, such as the elderly, fragile newborns, and immunocompromised patients increases the need for rapid and accurate assessment of microbiological data. Such developments make it increasingly important to identify the pathogen causing disease and to determine which antibiotics will be most effective in treatment.

In addition, as technologies and information have expanded beyond the knowledge base of the clinical user, the consultative role of the clinical microbiologist has become increasingly more important, the report says. "The clinical microbiologist is in the best position to give advice on the available procedures for accurately and promptly establishing a diagnosis and for monitoring therapy."

Moreover, the report notes that the decrease in the ratio of inpatients to outpatients and the increase in the range of outpatient procedures being performed has created a demand for even faster laboratory service, so that information can be available to the physician while the patient is still in the office or clinic. In addition, decreases in lengths of hospital stay require that laboratory turnaround be as rapid as possible.

"These changes increase the pressure to provide preliminary microbiological findings before the final results become available," says Rose. But the technological revolution offers a potential solution. "Improvements in technology transfer, such as electronic mail, from the lab to the clinic can greatly reduce turnaround time even when the lab is in a remote location."

"In the last analysis, it is the integrity of the clinical microbiologist that will ensure that the quality of patient care remains the central focus of the discipline. The future of clinical microbiology depends upon the initiative and vision of today's clinical microbiologists and on their abilities to educate the health care community about the key role of clinical microbiology in understanding the complex, evolving environment of pathogens and infectious diseases in a changing world," the report concludes.

Rose's co-chair on the colloquium steering committee was John M. Matsen of the University of Utah Medical Center. Other members of the steering committee included Drs. Patricia Charache, Johns Hopkins University School of Medicine; W. Michael Dunne, Henry Ford Medical Center; and Peter H. Gilligan, University of North Carolina Hospitals.

The American Academy of Microbiology, a component of the American Society for Microbiology, is the only honorific organization devoted entirely to microbiologists and the science of microbiology. The American Society for Microbiology is the largest single life science society in the world, with over 42,000 members representing a broad spectrum of disciplines in the microbiological sciences, including medical, environmental, and public health microbiology as well as infectious diseases. The Society's mission is to promote a better understanding of basic life processes and the application of this knowledge for improved health and environmental well being.

The colloquium report is available on the World Wide Web at http://www.asmusa.org/acasrc/aca1.htm. It can also be obtained by faxing a request to 202-942-9380 or e-mailing a request to academy@asmusa.org.

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