Nawawi H, Lim H H, Zakiah I
Department of Pathology, Hospital UKM, Kuala Lumpur, Malaysia.
Southeast Asian J Trop Med Public Health. 1999;30 Suppl 3:39-45.
An activity supportive of the MOH QA Programme, the National EQAS for clinical chemistry monitors for analytical performance in core routine biochemical testing by the pathology laboratories, with unsatisfactory performance scores serving to alert against deficiencies or problems and the scores in subsequent challenges providing the feedback of effectiveness of remedial actions taken. While unacceptable individual analyte performance score (variance index score, VIS) indicated problems in instruments, reagent and calibrators, or the use of inherently poorer methods, repeated occurrence of unsatisfactory OMRVIS was traceable to generally poor laboratory management of usually inadequately-equipment small laboratories. The outcome has been one of slow but gradual improvement in the overall performance of participating laboratories, with a move towards methods upgrading and standardization to achieve greater concordance of results. Presently, the programme is limited to 61 government and 4 private hospital laboratories in the country for 12 commonly assayed clinical biochemistry analytes. It is hoped that the NEQAS could be extended to the other private laboratories and that of academic institutions. However, this is dependent to a large extent on the manpower and financial support obtainable by the organizing body of the programme in the future. Belk and Sunderman, 1947 demonstrated that laboratories participating in an quality assessment scheme could rapidly and dramatically improve their analytical performance. In some countries, participation has become mandatory, and acceptable performance is a requirement in laboratory accreditation. The need and value of the NEQAP is, therefore, evident. While there may be limitations in the national programme. efforts are being made at improving the programme within the means and resources of the organising body. The goals of the NEQAP are not just to monitor performance but also to educate. On this, matters related to and supportive of these goals have also been pursued. The annual workshop/forum on quality controls had allowed exchange of information between representatives of participating laboratories and the organising body. Recently in the 1997 MOH Quality Improvement evaluation, Quality Control has been evaluated together with the other 17 such activities. The study on knowledge, attitude and practice has provided the necessary feedback and will be used for future planning in making efforts at increasing the effectiveness and benefits of the all QC activities including this NEQAP for clinical chemistry. In addition, there is a need to look into areas such as selection of methods and test systems, and improvement of continuing education, training as well as research in quality improvement as suggested by the Quality Improvement evaluation.
作为支持卫生部质量保证计划的一项活动，国家临床化学外部质量评估计划监测病理实验室核心常规生化检测的分析性能，不满意的性能得分用于警示缺陷或问题，后续挑战中的得分则提供所采取补救措施有效性的反馈。虽然单个分析物的不可接受性能得分（变异指数得分，VIS）表明仪器、试剂和校准品存在问题，或者使用了本质上较差的方法，但OMRVIS（总体变异指数得分）反复出现不满意情况可追溯到设备通常不足的小型实验室普遍较差的实验室管理。结果是参与实验室的整体性能缓慢但逐步得到改善，朝着方法升级和标准化迈进以实现结果的更大一致性。目前，该计划仅限于该国的61家政府实验室和4家私立医院实验室，针对12种常用的临床生化分析物。希望NEQAS能够扩展到其他私立实验室和学术机构的实验室。然而，这在很大程度上取决于该计划的组织机构未来可获得的人力和财政支持。Belk和Sunderman在1947年证明，参与质量评估计划的实验室能够迅速且显著地提高其分析性能。在一些国家，参与已成为强制性要求，可接受的性能是实验室认可的一项要求。因此，NEQAP的必要性和价值是显而易见的。虽然国家计划可能存在局限性，但正在努力在组织机构的财力和资源范围内改进该计划。NEQAP的目标不仅是监测性能，还包括教育。在此方面，也一直在追求与这些目标相关并支持这些目标的事项。年度质量控制研讨会/论坛允许参与实验室的代表与组织机构之间交流信息。最近在1997年卫生部质量改进评估中，质量控制与其他17项此类活动一起进行了评估。关于知识、态度和实践的研究提供了必要的反馈，并将用于未来规划，以努力提高包括该临床化学NEQAP在内的所有质量控制活动的有效性和效益。此外，有必要研究诸如方法和测试系统的选择，以及如质量改进评估所建议的在质量改进方面继续教育、培训以及研究的改进等领域。
