From the Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston (Singh, Dowlin, Chong).
Amazon.com, Inc, Seattle, Washington (Nakamoto).
Arch Pathol Lab Med. 2021 Jul 1;145(7):821-824. doi: 10.5858/arpa.2021-0058-SA.
CONTEXT.—: Coronavirus disease 2019 (COVID-19) changed the dynamics of health care delivery, shifting patient priorities and deferring care perceived as less urgent. Delayed or eliminated care may place patients at risk for adverse outcomes.
OBJECTIVE.—: To identify opportunities for laboratory test stewardship to close potential gaps in care created by the COVID-19 pandemic.
DESIGN.—: The study was a retrospective time series design examining laboratory services received before and during the COVID-19 pandemic at a large metropolitan health system serving women and children.
RESULTS.—: Laboratory test volumes displayed 3 distinct patterns: (1) a decrease during state lockdown, followed by near-complete or complete recovery; (2) no change; and (3) a persistent decrease. Tests that diagnose or monitor chronic illness recovered only partially. For example, hemoglobin A1c initially declined 80% (from 2232 for April 2019 to 452 for April 2020), and there was a sustained 16% drop (28-day daily average 117 at August 30, 2019, to 98 at August 30, 2020) 4 months later. Blood lead dropped 39% (from 2158 for April 2019 to 1314 for April 2020) and remained 23% lower after 4 months.
CONCLUSIONS.—: The pandemic has taken a toll on patients, practitioners, and health systems. Laboratory professionals have access to data that can provide insight into clinical practice and identify pandemic-related gaps in care. During the pandemic, the biggest patient threat is underuse, particularly among tests to manage chronic diseases and for traditionally underserved communities and people of color. A laboratory stewardship program, focused on peri-pandemic care, positions pathologists and other laboratory professionals as health care leaders with a commitment to appropriate, equitable, and efficient care.
2019 年冠状病毒病（COVID-19）改变了医疗保健服务的动态，改变了患者的优先级，并推迟了被认为不太紧急的治疗。延迟或取消治疗可能使患者面临不良后果的风险。
确定实验室检测管理的机会，以缩小 COVID-19 大流行造成的潜在护理差距。
该研究是一项回顾性时间序列设计，在一家为妇女和儿童服务的大型大都市卫生系统中，研究 COVID-19 大流行前后的实验室服务。
实验室检测量显示出 3 种不同的模式：（1）在州封锁期间下降，然后几乎完全或完全恢复；（2）无变化；（3）持续下降。诊断或监测慢性病的检测仅部分恢复。例如，血红蛋白 A1c 最初下降了 80%（从 2019 年 4 月的 2232 下降到 2020 年 4 月的 452），4 个月后持续下降了 16%（28 天平均每日 117 下降到 2020 年 8 月 30 日的 98）。血铅下降了 39%（从 2019 年 4 月的 2158 下降到 2020 年 4 月的 1314），4 个月后仍低 23%。
大流行给患者、医生和卫生系统带来了沉重的打击。实验室专业人员可以访问数据，这些数据可以深入了解临床实践，并发现与大流行相关的护理差距。在大流行期间，最大的患者威胁是使用率低，尤其是在管理慢性病和传统服务不足的社区和有色人种的测试中。一个以大流行前护理为重点的实验室管理计划，使病理学家和其他实验室专业人员成为医疗保健领导者，致力于提供适当、公平和高效的护理。
