Application of 3-D Delta check graphs to HbA1c quality control and HbA1c utilization.

Abstract:

:Delta checking is a laboratory information system (LIS)-based tool that detects patient and laboratory quality control errors. By using hemoglobin A1c (HbA1c) data, we developed a novel approach to summarizing and presenting patient Delta values to address limitations of current Delta check algorithms. Delta values were calculated from intrapatient pairs of HbA1c (n = 55,327) measured during 2 years in a single referral or a university hospital laboratory. Three-dimensional Delta-time (DeltaT) and percentile limit graphs were constructed. Cumulative distribution function analysis was used to explore clinical utilization. The DeltaT graphs showed that HbA1c Delta values increase asymmetrically over time. Although the 2.5 to 97.5 and 5.0 to 95.0 percentile Delta check limits were similar for both sites, the referral laboratory's 0.5 to 99.5 percentile limits were wider. For acute patient care environments, we recommend limits of -3.5% and 1.8% for measurements between 0 and 60 days and -4.0% and 2.0% for measurements between 60 and 120 days. For the outpatient environment, we recommend limits of -4.2% and 2.1% and 5.0% and 2.5% for measurements between 0 and 60 days and 60 and 120 days, respectively.Delta checking can be significantly improved with customization of limits set by population and interobservation period. Because LIS systems are incapable of these customizations, customers must become advocates for these modifications.

journal_name

Am J Clin Pathol

authors

Tran DV,Cembrowski GS,Lee T,Higgins TN

doi

10.1309/VM6FVF6GGCYYJ9BV

subject

Has Abstract

pub_date

2008-08-01 00:00:00

pages

292-8

issue

2

eissn

0002-9173

issn

1943-7722

pii

CG370584K5351804

journal_volume

130

pub_type

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