Ann Clin Microbiol.  2013 Jun;16(2):61-68. 10.5145/ACM.2013.16.2.61.

A Proposal for Laboratory Workflow Changes for Efficient Tuberculosis Control

• Kim CK
• Sung H
• Park YJ
• Chang CL

• KMID: 1431766
• DOI: http://doi.org/10.5145/ACM.2013.16.2.61

Abstract

There are several problems in mycobacterial detection and drug susceptibility testing. One problem is that some test results are unnecessarily delayed because the tests are postponed until patients revisit clinics and pay the cost of the tests. Another problem is that critical and important tests are not requested because patients do not agree with their necessity. These inefficient practices may be due to the fee-for-service policy that the Korean medical insurance system is adopting and because many test methods used for mycobacterial infection have each test codes. Therefore, we propose a new test code encompassing several test items necessary for laboratory diagnosis of mycobacterial infection. This new code enables all necessary tests to be performed sequentially without delay and also prevents performance of unnecessary tests. These changes will help control tuberculosis without any further medical insurance financial input.

Keyword

Laboratory diagnosis of tuberculosis; Laboratory workflow; Tuberculosis control

MeSH Terms

Clinical Laboratory Techniques
Humans
Insurance
Tuberculosis

Figure

• 

  Fig. 1. The workflow of laboratory tests for the diagnosis of tuberculosis or other mycobacterial infection. (A) current status, and (B) suggestion of workflow changes. Abbreviations: MTB, Mycobacterium tuberculosis; NTM, nontuberculous mycobacteria; AST, antibiotic susceptibility test; MAC, Mycobacterium avium complex; RGM, rapidly growing mycobacteria.

• 

  Fig. 1. Continued.

Reference

1.World Health Organization. Global tuberculosis report 2012. Publication No. WHO/HTM/TB/2012.6.http://www.who.int/tb/publi-cations/global_report/en/index.html. [Online] (last visited on 15 May 2013).

2.Korean Hospital Association. Geongang Boheom Yoyang Geubyeo Biyong. Korean Hospital Association. 2013.

3.Griffith DE., Aksamit T., Brown-Elliott BA., Catanzaro A., Daley C., Gordin F, et al. ATS Mycobacterial Diseases Subcommittee; Ameri-can Thoracic Society; Infectious Disease Society of America. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007. 175:367–416.

4.Joint Committee for the Development of Korean Guidelines for Tuberculosis, and Korea Centers for Disease Control and Prevention. 2011. Korea Guidelines for Tuberculosis.http://www.lungkorea.org/thesis/file/%B0%E1%C7%D9%C1%F8%B7%E1%C1%F6%C4%A7-%-C3%D6%C1%BE20110608.pdf. [Online] (last visited on 15 May 2013).

5.Jeong SH., Lee DD., Choi JC., Kim S., Shin JH., Jeong J, et al. Multicenter study on cost effectiveness of antituberculosis drug susceptibility test. Infect Chemother. 2005. 37:16–21.

6.Kim SJ., Espinal MA., Abe C., Bai GH., Boulahbal F., Fattorin L, et al. Is second-line antituberculosis drug susceptibility testing reliable? Int J Tuberc Lung Dis. 2004. 8:1157–8.