Diagnostic Test Utilization Management Strategies as an Opportunity for Equitable Access to Molecularly Informed Clinical Care.
Diagnostic Test Utilization Management Strategies as an Opportunity for Equitable Access to Molecularly Informed Clinical Care.
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诊断测试利用管理策略作为公平获得分子信息临床护理的机会。
DOI：
10.1093/jalm/jfad079
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Lennerz,JochenK
中科院分区：
文献类型：
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作者：
Hou,HelenX;Li,Annie;Thierauf,JuliaC;Lennerz,JochenK
背景同伴诊断学是肿瘤学的重要组成部分。时间、成本和对新药/生物标记物批准的适应性是确保基于价值的护理的挑战。克服这些挑战需要公平获取和有效整合的战略。方法基于以前的实验室改进和付款人政策实施，我们定义了实验室检测中的公平获取，并概念化了优化诊断性能的倡议的框架。结果我们将公平获取定义为寻求消除因经济困难、地理隔离、文化差异或其他社会健康决定因素而产生的差异的迫切目标。我们区分了(A)利用，作为有序测试的实践模式，(B)利用管理，作为利用决策的循证指导，以及(C)利用管理策略，定义为用于影响决策的工具和技术。这三个维度建立了一个标准化的词汇，以澄清特定护理路径中战略的公平匹配。在创建可持续的个性化护理路径计划时，物流、管理和财务激励结构的协调至关重要。结论公平和有意义地使用诊断测试的策略有助于提高获得及时和准确诊断的机会，最终改善患者的预后。
BackgroundCompanion diagnostics are an essential component of oncology. Timing, cost, and adaptability to new drug/biomarker approvals represent challenges in assuring value-based care. Overcoming these challenges requires strategies for equitable access and efficient integration.MethodsBased on prior laboratory improvements and payor policy implementations, we define equitable access in laboratory testing and conceptualized a framework for initiatives that optimize diagnostic performance.ResultsWe define equitable access as an imperative goal seeking to remove disparities that may arise due to financial hardships, geographical isolation, cultural differences, or other social determinants of health. We distinguish (a) utilization, as the practice pattern of ordered tests, (b) utilization management, as the evidence-based guidance of the utilization decisions, and (c) utilization management strategies, defined as the tools and techniques used to influence decision-making. These 3 dimensions establish a standardized vocabulary to clarify equitable alignment of strategies in specific care pathways. Alignment of logistic, administrative, and financial incentive structures is paramount when creating sustainable personalized care pathway programs.ConclusionsStrategies to accomplish equitable and meaningful use of diagnostic tests can help enhance access to timely and accurate diagnoses, ultimately leading to improved patient outcomes.