Outsourcing of Academic Clinical Laboratories: Experiences and Lessons From the Association of Pathology Chairs Laboratory Outsourcing Survey
Outsourcing of Academic Clinical Laboratories: Experiences and Lessons From the Association of Pathology Chairs Laboratory Outsourcing Survey
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DOI：
10.1177/2374289518765435
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发表时间：
2018-04-02
影响因子：
1
通讯作者：
Tomaszewski, John E.
中科院分区：
文献类型：
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作者：
Mrak, Robert E.;Parslow, Tristram G.;Tomaszewski, John E.
美国医院越来越多地转向服务外包以降低成本，包括实验室服务。对这种做法的研究主要集中在非学术医疗中心。相比之下，学术医疗中心有独特的实践环境和独特的使命考虑。我们试图阐明和分析美国学术医疗中心的临床实验室外包经验。17位有相关经验的病理学教授愿意参加关于他们经验的深入访谈。由于测试定价、管理费、支助住院病人的服务重复以及营利伙伴缺乏控制使用情况的激励，合资安排的预期财务效益往往在协议最初几年后受到侵蚀。外包可能会妨碍利润丰厚的外联方案的发展;在一些情况下，这种方案是在合资企业被避免或终止后成功启动的。常见的投诉包括测试周转时间差和测试质量问题（特别是在分子病理学，微生物学和流式细胞术），导致临床医生不满。合资企业对学术导向的临床病理学教师的保留产生不利影响，对研究和教育产生不利影响，这进一步加剧了临床医生的不满，由于缺乏可用的咨询专业知识。病理学和其他学科（特别是传染病）的住院医师教育既缺乏现场实验室能力，也缺乏师资。大多数合资企业是在病理学领导层很少或根本没有投入的情况下启动的，在这种安排被拒绝或终止的情况下，病理学领导层的投入被认为是至关重要的。
American hospitals are increasingly turning to service outsourcing to reduce costs, including laboratory services. Studies of this practice have largely focused on nonacademic medical centers. In contrast, academic medical centers have unique practice environments and unique mission considerations. We sought to elucidate and analyze clinical laboratory outsourcing experiences in US academic medical centers. Seventeen chairs of pathology with relevant experience were willing to participate in in-depth interviews about their experiences. Anticipated financial benefits from joint venture arrangements often eroded after the initial years of the agreement, due to increased test pricing, management fees, duplication of services in support of inpatients, and lack of incentive for utilization control on the part of the for-profit partner. Outsourcing can preclude development of lucrative outreach programs; such programs were successfully launched in several cases after joint ventures were either avoided or terminated. Common complaints included poor test turnaround time and problems with test quality (especially in molecular pathology, microbiology, and flow cytometry), leading to clinician dissatisfaction. Joint ventures adversely affected retention of academically oriented clinical pathology faculty, with adverse effects on research and education, which further exacerbated clinician dissatisfaction due to lack of available consultative expertise. Resident education in pathology and in other disciplines (especially infectious disease) suffered both from lack of on-site laboratory capabilities and from lack of teaching faculty. Most joint ventures were initiated with little or no input from pathology leadership, and input from pathology leadership was seen to have been critical in those cases where such arrangements were declined or terminated.