Research Of Clinical Laboratory Status And Feasibility Survey Of Inspection Items Setup In Community Health Service In Shanghai

Research of clinical laboratory status and rational inspection items setup in Community Health Service in ShanghaiBackgroundFollowing by the developing of clinical medicine and biomedicine, laboratory medicine have been on the highway of a new period. Laboratory medicine has become more and more important in the fields of clinical diagnosis, disease control and science researches. Laboratory medicine is the indispensable part of the medicine fields. Laboratory medicine has used auto-machine system instead of manual operation through the technological revolution.As the important part of public health network, Community Health Service fully used the community health resource offer six kind of services concluding preventing, health care, healing, medical treatment, health promotion and Planned Parenthood.The Quality of the inspection in community health service is much lower than large-scale hospital. The data of blind spot investigation in 2008 which surveyed 20 community health service shows that there were 35% hospitals one sample test results had no error,7.5% hospitals disqualification (one sample test results had over three errors). There is no disqualification in large-scale hospital in the same investigation.The Bureau of Public Health in Changning district of Shanghai reformed the clinical laboratory in 9 community health service in early 2008. In this reformation, the Bureau of Public Health requires clinical laboratory let the immune and biochemical samples tested by Labway Clinical Laboratory, only hold the haemal and humoral samples. Shanghai Labway Clinical Laboratory is an independent clinical laboratory (ICL).The ICL was established in 1950's in America. The ICL has a perfect system of quality control and laboratory management, which could offer more accurately and effectively test result in the developed countries.Through the research, we want to compare difference of the two forms of clinical laboratory the ICL and the laboratory in the community health service. To find which kind of clinical laboratory form is suitable to the community health service, which kind of clinical laboratory form has more preponderance in cost and resource using? At the view of economics, the research is paying attention to analyzing the health service efficiency through the survey of clinical laboratory status.ObjectivesIt aims to setup rational inspection items and improve the whole test quality and efficiency of clinical laboratory through effectively using health resource and propriety reducing healthy cost.Contents1. To find out the status of clinical laboratory in community health service.2. To analyze the efficiency of the inspection items in the community health service.(1) To compute the inspection items cost in community health service.(2) To compare the cost of inspection items between the difference sample quantities using the same machine. To compare the different cost of inspection items between same sample quantities using the different machine.(3) To compare cost-effective between the clinical laboratory in community and ICL.3. Through the analyze the status of clinical laboratory in community, to find the problem and summarize the situation, supply the list of rational inspection items setup.MethodFirst, describe the status of clinical laboratory in community health service. Second, compute the inspection items cost using Activity-Based Cost. Compare the difference between clinical laboratory in community and ICL. Third, affirm the suitable list of inspection items through the quality research.Results1. The status of clinical laboratory in community health service。A unit of community health service can cover with 827,000 people. The main facilities in community are automatic biochemistry analyzer, automatic hematology analyzer, urine chemistry analyzer, there ratio are 96.67%,115.23% and 109.52%.Through the research we can find that some community health service have two automatic hematology analyzer and urine chemistry analyzer of each. The average incoming of clinical laboratory in community is about￥1.95 million one year. In community health service, there are about 4% people working in the laboratory. About 53.11% people are graduated from middle school and about 32.35% people are graduated from college. There are 1.29% people are high technical post,22.74% at the middle technical post and 71.63% at the junior technical post. The execution of the system of biological safety is not very well.2. The rate of the reagent price to the inspections items cost is low. The rate of biochemical items is 47.76%.The rate of hematology items is 8.33% and 10.33% in urine chemistry items. The rate of reagent price in ELISA method cost is 4.44% and 2.82% using the Colloidal Gold Device. The manpower cost is higher than the reagent cost, especially through the double check. Compared with the community laboratory, the ICL have the higher reagent cost, the proportion is about 61.59%.Because of the large-scale testing, manpower cost is cheaper than the lab in community, at about 21.01%. The inspection qualities of labs in community are lower than in the ICL's. Compared the two kind of inspection form, ICL has the higher efficiency in Shanghai.3. Based on the prevalence rate situation in community, to define the items list considering to select diagnosis items of high prevalence rate, high clinical effect, suitable technical risk and value, the propriety ability of inspection and the equipment.SuggestionThe suggestion of this research is based on the status of the community health service and clinical laboratory management system and considered about the social benefits and economic profit as well.In field of the policy, we should build a clinical laboratory system which is suitable for the community health service and improve on the management system which conclude shanghai center for clinical laboratory (SCCL), the second grade network combined by the secondary hospital and the community health service.In the field of technology, we should draw up the standard which helps to training the technician and trying to improve the technician ability. Strengthen the cooperation of doctors and technicians interior hospital and communication of the technicians between the hospitals. In the field of resource collocation, we should choose the suitable inspection service followed by the disease. Permitting hospital do the quick test and POCT items. Reduce the inspection time and promote the test efficiency. Support the development of the ICL and standard the market of clinical laboratory and reagent supply.