Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Analysis of Relevant Factors and External Quality Assessment in Small-Medium Sized Hospital

중소의료기관의 외부정도관리 시행과 관련요인 분석

  • Kim, Hye-Jeong (Division of Biomedical Laboratory Science, Kyungwoon University)
  • 김혜정 (경운대학교 임상병리학과)
  • Received : 2018.10.26
  • Accepted : 2019.02.01
  • Published : 2019.02.28
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Abstract

Korean hospitals implement external quality assessment (EQA) schemes to improve the quality of clinical tests. However, smaller hospital do not implement EQA due to lack of appreciation and cost burdens. The purpose of this study was to analyze the results of EQA from the perspective of clinical chemistry carried out at a small-to-medium sized hospital (SMH) and to investigate factors influencing quality control. The medical institution concerned had performed EQA on 21 items annually for three years and had analyzed measurement methods, variation coefficients, and anomalous results as defined by the SMH. No significant change in test methods or variation coefficients, which exhibited a high level of variation, were observed for any test item over the 3-year period. The results obtained showed that anomalous test results were significantly more frequent when EQA was not conducted (p<0.05), internal quality control was not conducted daily (p<0.01), and when tests were less frequently performed (p<0.01). Small-to-medium sized hospitals need to be more aware of the benefits of EQA and provide tailored education to staff.

국내 의료기관은 임상 검사의 질 향상을 위하여 외부 정도관리를 시행하고 있으나 일차 의료기관의 경우 기관장의 인식부족 및 비용에 대한 부담으로 미시행하고 있는 실정이다. 본 연구는 중소 의료기관을 대상으로 임상 화학 분야 외부정도관리를 시행하고 종합병원 이상의 의료기관 외부정도관리 결과와 비교해 보며, 정도관리에 영향을 주는 관련요인에 대하여 분석해 보았다. 중소 의료기관을 대상으로 3년간 년 1회 임상화학 분야 21개 종목의 외부 정도관리를 실시하고 항목별 분석방법, 변이계수, 의료기관의 특성에 따른 이상치를 분석하였다. 검사 항목별 분석 방법 및 변이 계수는 3년간 특이적 변화는 보이지 않았으며, 중소 의료기관은 임상화학 검사의 분석방법이 다양하고 변이계수가 높게 나타났다. 정도관리에 영향을 주는 이상치(poor value)와 같은 오류 발생은 외부 정도관리를 실시하지 않을수록(p<0.05), 내부 정도관리의 주기가 매일 이루어지지 않을수록(p<0.01), 검사 량이 적은 의료기관 일수록(p<0.01) 많이 발생하는 것으로 유의하게 나타났다. 중소 의료기관의 외부 정도관리에 대한 인식 개선과 중소 의료기관 종사자를 위한 맞춤식 교육이 필요하다 하겠다.

Keywords

Table 1. Control material provided for analysis and number of participating laboratories from 2016 to 2018

SHGSCZ_2019_v20n2_294_t0001.png 이미지

Table 2. Reference values according to the major methods used in clinical chemistry test

SHGSCZ_2019_v20n2_294_t0002.png 이미지

Table 3. Analytical methods used in clinical chemistry from 2016 to 2018

SHGSCZ_2019_v20n2_294_t0003.png 이미지

Table 4. Annual changes in CVs according to the test from 2016 to 2018

SHGSCZ_2019_v20n2_294_t0004.png 이미지

Table 5. Relativity analysis of number of the poor value according to quality management test, medical check up and class of hospital in 2018

SHGSCZ_2019_v20n2_294_t0005.png 이미지

Table 6. Correlational analysis of number of the chemistry samples tested per day and poor value

SHGSCZ_2019_v20n2_294_t0006.png 이미지

References

  1. J. Buttner, R. Borth, P. M.. Broughton, R. C. Bowyer, "Approved recommendation (1983) on quality control in clinical chemistry IV Internal quality control", J Clin Chem Clin Biochem, Vol.21, No.12, pp. 877-884, 1983.
  2. M. M. Rizk, N. A. el-Badawi, P. E. Moez, A. A. Khattab, "Implementation of quality control performance criteria and approved guidelines for upgrading of clinical chemistry laboratory procedures in Alexandria University hospitals", Clin Biochem, Vol.42, No.4-5, pp. 288-292, 2009. DOI: https://doi.org/10.1016/j.clinbiochem.2008.09.013
  3. Y. K. Lee, "Annual Report on the External Quality Assessment Scheme for Routine Hematology in Korea (2016)", J Lab Med Qual Assur, Vol.39, No.2, pp. 53-60, 2017. DOI: https://doi.org/10.15263/jlmqa.2017.39.2.53
  4. M. Han, H. E. Chang, K. U. Park, J. Song, K. S. Han, "Serum ferritin levels for normal hemoglobin blood donors in a Korean population", Korean J Blood Transfus, Vol.22, No.2, pp. 127-33, 2011.
  5. W. G. Miller, "The role of proficiency testing in achieving standardization and harmonization between laboratories", Clin Biochem, Vol.42, pp. 232-235, 2009. DOI: https://doi.org/10.1016/j.clinbiochem.2008.09.004
  6. Korean Association of External Quality Assessment Service. Reliability survey. KAEQAS. Available From: http://eqas.keqas.org/ (accessed October, 24, 2018).
  7. College of American Pathologists. 2019 surveys catalog. CAP. Available From: http://www.cap.org/ShowProperty?nodePath=/UCMCon/ Contribution%20Folders/WebContent/pdf/2019-surveys-c atalog.pdf (accessed October, 24, 2018).
  8. Asian Network for Clinical Laboratory Standardization. Asian Quality Assurance Survey Program. ANCLS. Available From: http://ancls.org/ (accessed October, 24, 2018).
  9. United Kingdom National External Quality Assessment. International Quality Expertise. UK NEQAS. Available From: http://www.ukneqas.org.uk/ (accessed October, 24, 2018).
  10. KS Han, MH Park, SI Kim. Transfusion medicine. 3rd ed. p.156-159, Seoul Korea Medical Book Publisher, 2006.
  11. S. H. Jun, J. H. Song, W. H. Song, "Annual Report on the External Quality Assessment Scheme for Clinical Chemistry in Korea (2015)", J Lab Med Qual Assur, Vol.38, No.3, pp. 111-119, 2016. DOI: https://doi.org/10.15263/jlmqa.2016.38.3.120
  12. Y. W. Lee, B. R. Jeon, J. G. Kim, S. H. Jun, Y. M. Yun, S. I. Chun, J. H. Song, W. K. Min, "Annual Report on the External Quality Assessment Scheme for Clinical Chemistry in Korea (2016)", J Lab Med Qual Assur, Vol.39, No.2, pp. 61-75, 2017. DOI: https://doi.org/10.15263/jlmqa.2017.39.2.61
  13. Clinical and Laboratory Standards Institute. Using proficiency testing to improve the clinical laboratory; approved guideline-second edition. p. 1-45, CLSI. Document GP27-A2. Wayne, PA: CLSI., 2007.
  14. Korea Society of Laboratory Medicine. Laboratory medicine. 5th ed. p.46-47, Seoul, Panmuneducation, 2014.
  15. C. H. Ihm, H. S. Lim, "Quality Management of Clinical Chemistry Tests in Blood Center", Korean J Blood Transfus, Vol.28, No.1, pp. 1-12, 2017. DOI: https://doi.org/10.17945/kjbt.2017.28.1.1
  16. S. S. Cho, M. S. Kim, K. A. Shin, "Chemical Preservation Methods of Urine Sediment for Quality Control", Korean J Clin Lab Sci, Vol.49, No.4, pp. 359-365, 2017. DOI: https://doi.org/10.15324/kjcls.2017.49.4.359