Clinical pathology selected abstracts

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Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia.

Evaluating adoption of laboratory practice guidelines

July 2020—The College of American Pathologists launched the Pathology and Laboratory Quality Center for Evidence-Based Guidelines in 2009 to develop and promote laboratory practice guidelines (LPGs) using the National Academy of Medicine’s (NAM) standards for developing trustworthy guidelines. The center has published 17 evidence-based LPGs, including updated versions, using NAM’s criteria. In 2013, the CAP was awarded a five-year cooperative agreement grant from the Centers for Disease Control and Prevention to increase the effectiveness of its LPGs. The intent of the agreement was to assess awareness and adoption of two CAP LPGs: IHC assay validation (IHC VAL) and initial workup of acute leukemia (AL). The authors performed baseline surveys of the LPGs in 2010 and 2015, respectively. A follow-up study consisting of surveys, telephone interviews, and focus group sessions was conducted with labs that perform IHC testing to measure the adoption of guideline recommendations and inform future versions. The CAP has planned a follow-up study for the acute leukemia LPG. The IHC survey analyzed 1,624 survey responses, 40 telephone interviews, and discussions with participants from five focus groups. The response rates for the survey modalities were 46 percent, 13 percent, and three percent, respectively. Most respondents were aware of the LPG and had adopted most or all of its recommendations. Feedback on the IHC survey indicated a need for continued communication, increased specificity, and more prescriptive recommendations when the guideline is updated. The written surveys, available in paper and electronic formats, were identified as the easiest to use and had good response rates and quantitative results that were easy to interpret. Telephone interviews, conducted for the CAP by an outside consultant, proved to be more time-consuming than the written interviews. Based on these findings from the IHC VAL guideline survey, the authors recommended using preselected laboratories willing to participate in telephone interviews, rather than ran­dom sampling, for the AL guideline. The focus group sessions in the IHC VAL guideline survey were the most complicated modality to execute but revealed unexpected findings. For example, the focus group discussions, as well as the follow-up telephone interviews, indicated some confusion between the LPG recommendations and CAP Laboratory Accreditation Program requirements. The authors concluded that the IHC VAL guideline survey helped identify gaps in LPG awareness, adoption, and effectiveness. Identifying these gaps helps improve testing practices in support of better patient care. Of all survey modalities, the written and electronic formats were the most feasible for collecting information and had the highest response rates.

Goldsmith JD, Fitzgibbons PL, Fatheree LA, et al. Evaluating the adoption of laboratory practice guidelines. Arch Pathol Lab Med. 2020;144(1):83–89.