Diagnostic error reduction in the United States and Italy through the intervention of diagnostic management teams

A major challenge to most countries is the growing cost of healthcare. The cost of laboratory testing is approximately 3% of the total clinical costs. On the other hand, waste from inappropriate admissions to clinical departments is reported to be as high as 15%. A frequently used approach to save dollars in healthcare is the random reduction in the budget for laboratories, with a focus on reduction of the number of unnecessary laboratory tests. The World Health Assembly has approached the problem by publishing a list of essential in vitro diagnostic tests, in order to achieve a global rationalization of the problem. A much more thoughtful strategy to saving healthcare finance is to improve the efficiency of the diagnostic process. This report presents an opportunity to reduce diagnostic error and increase the efficiency of diagnostic testing. Reduction in time to a correct diagnosis provides a major financial as well as a clinical benefit. In addition, reducing both overutilization and underutilization of laboratory tests while achieving the correct diagnosis is a major benefit to challenged healthcare budgets. One approach taken to achieve major savings in healthcare has been the creation of “Diagnostic Management Teams,” composed of experts in specialty areas of medicine who are primarily based in the clinical laboratory to advise physicians on the selection of only necessary tests and the interpretation of complex test results

The 2020 “WHO technical specifications for automated non-invasive blood pressure measuring devices with cuff”

High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2; 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment.The 2020 “WHO Technical Specifications for Automated Non-Invasive Blood Pressure Measuring Devices With Cuff” was supported financially by the World Health Organization and Resolve to Save Lives. O. John is a recipient of Australia University International Postgraduate Awards scholarship from University of New South Wales, Sydney. T.M. Brady received support from Resolve to Save Lives, which is funded by Bloomberg Philanthropies, the Bill and Melinda Gates Foundation, and Gates Philanthropy.http://hyper.ahajournals.orgam2022School of Health Systems and Public Health (SHSPH

Medical and Assistive Health Technology: Meeting the Needs of Aging Populations

International audiencePurpose of the Study: To identify policy gaps in the delivery and availability of assistive health technology (AHT) and medical devices (MD) for aging populations, particularly in low-and middle-income countries (LMICs). Design and Methods: The findings presented in this paper are the results of several narrative overviews. They provide a contextual analysis of the conclusions and evidence from WHO commissioned research and expert consultations in 2013 and 2014, as well as a synthesis of literature reviews conducted on AHT and MD. Results: Practical, life-enhancing support for older people through AHT, MD, and related health and social services is a neglected issue. This is particularly so in LMICs where the biggest increases in aging populations are occurring, and yet where there is commonly little or no access to these vital components of healthy aging. Implications: Health technologies, especially medical and assistive health technology, are essential to ensure older people's dignity and autonomy, but their current and potential benefits have received little recognition in LMICs. Viewing these technologies as relevant only to disabled people is an inadequate approach. They should be accessible to both older adults with disabilities and older adults with functional limitation. Many countries need much greater official awareness of older adults' needs and preferences. Such attitudinal changes should then be reflected in laws and regulations to address the specificities of care for older people