The Study And Analysis Of Interlaboratory Quality Investigation For Interpretative Commenting In Clinical Laboratory

ObjectiveThis study aimed to evaluate the ability of comment providers who were responsible for interpreting results in clinical laboratories in China,identify the main quality problems and current practice of interpretative commenting(IC),and explore the general pattern of quality assurance program,and provide advice to comment providers,clinical laboratories and external quality assessment(EQA)organizers.MethodsQuestionnaires were provided to clinical laboratories participating in the external quality assessment programs organized by the National Center for Clinical Laboratories of China in 2018.1912 of clinical laboratories and corresponding participants were included in this investigation.The questionnaire consisted of basic information and clinical cases.The cases information included age,gender,patient location,brief clinical information,relevant test results and reference range.The investigation was conducted in three rounds and five cases were released in each round.Key phrase options and textbox were provided for participants to simplify the report form for the first round of investigation.In the second round,participants gave interpretative comments based on clinical information and related questions.In the third round,participants provided comments without any guidance.After collecting data by web-bases EQA system,EQA organizers assigned scores to each key phrase of comments based on predetermined marking scale and calculated total score of each participant's answer.Non-parametric test and chi-square test was applied to compare the total score and passing rate of comment providers,which could help analyze the educational significance of this investigation.ResultsIn total,772(40.38%)?681(35.62%)and 552(28.87%)of clinical laboratories,and 1477?1131 and 877 participants from different provinces participated in each round of investigation,relatively.Majority of participants were laboratories technicians,which came from tertiary-A comprehensive hospitals.598(77.46%)513(75.33%)and 417(75.54%)clinical laboratories provided interpretative comments for clinicians.On average,97.38%and 95.38%of laboratories gave interpreting responsibility to deputy and senior technicians without physician qualification,while 76.89%of laboratories authorized personnel with medical licensing to interpret results.In addition,it was difficult to develop interpretative commenting in clinical laboratories under the circumstance of insufficient clinical information and professional knowledge.For each round,total score of participants that came from general hospital or laboratories that provided interpretative comments were higher than those from specialized hospital(P=0.048?0.008?0.025)or laboratories that didn't provide this service(P=0.001?0.012?0.026).Participants with physician qualifications had higher competency than those without(P=0.005,<0.001,<0.001).No matter how laboratories acquired clinical information,the participants performed better than those had difficulty in obtaining clinical data.With the increase and enhancement of the difficulty of cases,the comprehensiveness of clinical information,and the requirement of reporting form,the degree of involvement and the score of each round investigation decreased(P<0.001).However,by engaging every round of investigation,the passing rate of participants came from tertiary-A hospitals increased gradually,so as to laboratory physicians.The acceptance of participants with difficulty in obtaining clinical data increased significantly from 67.14%to 82.05%,while the growing rate of which for junior personnel was 3.5%.Among the 268 of participants who participated in the three rounds of this survey,38.80%of them were gradually familiar with the form of interpretative commenting,while 17.16%of them improved competency for interpreting results.ConclusionsThere are many quality problems in developing interpretative commenting.EQA program of interpretative commenting contribute to improve competency of participants and promote continuing professional development.Participants should expand their professional knowledge,accumulate clinical experience and engage the quality assurance program actively.Laboratories should strengthen the communication with clinicians,establish documentation system of interpretative commenting and qualification of comment providers and train and assess them regularly.EQA organizers should also improve the scoring method and establish peer assessors team through this survey,and promote standardization of current practice of interpretative commenting.