University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
Curetis USA Inc, San Diego, California, USA.
J Clin Microbiol. 2019 Aug 26;57(9). doi: 10.1128/JCM.00495-19. Print 2019 Sep.
Advanced microbiology technologies are rapidly changing our ability to diagnose infections, improve patient care, and enhance clinical workflow. These tools are increasing the breadth, depth, and speed of diagnostic data generated per patient, and testing is being moved closer to the patient through rapid diagnostic technologies, including point-of-care (POC) technologies. While select stakeholders have an appreciation of the value/importance of improvements in the microbial diagnostic field, there remains a disconnect between clinicians and some payers and hospital administrators in terms of understanding the potential clinical utility of these novel technologies. Therefore, a key challenge for the clinical microbiology community is to clearly articulate the value proposition of these technologies to encourage payers to cover and hospitals to adopt advanced microbiology tests. Specific guidance on how to define and demonstrate clinical utility would be valuable. Addressing this challenge will require alignment on this topic, not just by microbiologists but also by primary care and emergency room (ER) physicians, infectious disease specialists, pharmacists, hospital administrators, and government entities with an interest in public health. In this article, we discuss how to best conduct clinical studies to demonstrate and communicate clinical utility to payers and to set reasonable expectations for what diagnostic manufacturers should be required to demonstrate to support reimbursement from commercial payers and utilization by hospital systems.
先进的微生物学技术正在迅速改变我们诊断感染、改善患者护理和提高临床工作流程的能力。这些工具正在增加每个患者产生的诊断数据的广度、深度和速度,并通过快速诊断技术(包括即时检测技术)将检测更接近患者。虽然一些利益相关者已经认识到微生物诊断领域改进的价值/重要性,但临床医生与一些支付者和医院管理人员之间在理解这些新技术的潜在临床应用方面仍然存在脱节。因此,临床微生物学领域面临的一个关键挑战是,要明确阐述这些技术的价值主张,以鼓励支付者覆盖和医院采用先进的微生物学检测。关于如何定义和展示临床实用性的具体指导将是有价值的。应对这一挑战需要在这个问题上达成一致,不仅需要微生物学家,还需要初级保健和急诊室(ER)医生、传染病专家、药剂师、医院管理人员以及关注公共卫生的政府实体。在本文中,我们讨论了如何最好地进行临床研究,向支付者展示和传达临床实用性,并为诊断制造商应被要求证明以支持商业支付者的报销和医院系统的使用设定合理的期望。