Journal 2 Surrogate Biomarkers For Monitoring Healthcare Quality For Chronic Diseases Such As Diabetes Care

Journal 2
Surrogate biomarkers for monitoring healthcare quality for chronic diseases such as diabetes care
Medical laboratories are one of the key players in the provision of healthcare, and responsible for healthcare quality. In order to
create value-based health care, population-level outcomes and cost-effectiveness should be measured as well at the patient-level.
The test results from the electronic health records can be used for get-ting information about population-level health-care quality,
especially for chronic diseases. In this context, laboratory professionals can present some valuable information about the quality of
care to the health policy makers, since 70-85% of individuals admitted to a hospital have laboratory tests. It is suggested that quality
of care can be assessed according to the conceptualized frameworks suggested by Donabedian and the World Health Organization,
and randomized controlled trials (RCTs) are suggested as the best model for assessment. However, RCTs of diagnostic procedures
are not common because of the challenges in design and implementation. Electronic health records are providing new opportunities
with high data collection capacity and can be used for assessment of the population status with specific disease according to the
surrogate outcome measures such as HbA1c for diabetes monitoring. Although the information obtained from the real life data is
not enough for determination of the actual status, it can provide insights into further structured outcome studies. The data can be
used by policy makers, especially in countries where no outcome assessments have been performed at the patient and/or population
level. Laboratory professionals working in hospitals should have sufficient knowledge and skills in data management for extracting
meaningful information from patients’ test results besides their core professional knowledge. The objectives of this paper are to
emphasize roles of medical laboratory professionals in the value-based health care model, present the examples on diabetes care
quality, and to point out what competencies should be gained by laboratory professionals.
Quality measures have been used in order to assess and compare the healthcare quality of an organization, quality of health care
delivery services, and population health quality. The performance of health care is assessed by outcome measures. The EHRs are
being recognized as an important tool for research as well as clinical care. The main objective should be to learn data mining
techniques for extracting meaningful information from database obtained from the EHRs. The laboratory professionals with their
data mining knowledge complemented with their core professional knowledge should be part of the data management teams at the
hospitals along with epidemiologists and data scientists. They provide meaningful information from test results as a basis for
tracking chronic diseases and insights into public health trends, and can aid the management of public healthcare policies. Quality
indicators for several diseases, for ex-ample, diabetes care quality, are being defined by government organizations and by scientific
societies. Most of quality measurement in diabetes mainly includes measures of process and intermediate outcomes, such as HbA1c
as surrogate biomarker. Laboratory test results can be treated as part of indicative data and the findings from data mining can
provide meaningful knowledge to the policy makers at national and individual levels.
The HbA1c values of diabetics admitted to the hospitals were collected for 40 years together with the evidencie for the analytical
quality assurance. In the first 12 years, there were no electronic health records. The test results of diabetics were recorded on their
“diabetes test follow-up cards”. Our laboratory collected the results of glucose, HbA1c, and lipids tests and estimated the
percentages of poorly controlled diabetics (1982-1994) and 93% of diabetics had HbA1c values higher 7.0% (53 mmol/mol).
Furthermore, HbA1c results of diabetics admitted to the Center of the Turkish Diabetes Society in Denizli between 1999-2003 were
also collected and 53% of the patients had HbA1c values higher than 7.0% (53 mmol/mol). The HbA1c distributions established
from our research studies (2003-2005) and the distributions obtained from data extracted from the LISs (2017) are seen in the
Figures 1 and 2, respectively. The percentages of patients that have values outside the targets at the beginning and the 6th month can
be seen in the Table 1 extracted from our cohort study. All patient results were collected together with the evidence of analytical
quality assurance results of the laboratories.
Observations and findings from the studies have shown that laboratory professionals should be part of the data management team in
health care organizations along with epidemiologists, statisticians, data scientists, and professionals from relevant disciplines.
Laboratory professionals are one of the key players in health care services. They should be aware of the laboratory’s value in
improving the health of the population, not only the health of a single patient. The key issue is to realize what future challenges will
be and what skills should be gained in order to cope with these challenges. Additional skills may be acquired to use relevant
information technology and data mining methods in order to be part of the multidisciplinary teams.
Reference:
Aslan, D. (2019). The journal of the international federation of clinical chemistry and laboratory medicine. ISSN 1650-3414
Volume 29 Number 4.

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