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July 8, 1998

Accuracy of Physicians' Office Laboratory Results—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(2):129-132. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-2-jac80010

In Reply.— The authors of these letters note that clinical laboratory testing takes place in the broad and highly variable context of overall patient care. Our own comments explicitly acknowledge laboratory testing as a single aspect of ambulatory care delivery, and note the importance of several important preanalytic and postanalytic processes with respect to PT. However, the importance of analytic accuracy and reliability should not be underestimated. Many clinicians as well as laboratory scientists have recognized the importance of analytic performance goals and medical usefulness limits, and research in this arena has flourished in recent years.13 In one such study, Fraser et al1 define analytic goals as those standards of performance required to facilitate optimal patient care.1 Inherent is this definition is the notion than analytic requirements for any given analyte or test vary depending upon situational factors, such as the rationale for the test (ie, diagnosis, monitoring, or screening) and the care setting (eg, surgical suite of ambulatory care facility, physician office, or nursing home). Analytic goals also vary according to individual patient characteristics, such as specific comorbidity, age, mental status, and overall condition. Understanding the required analytic precision for a given test may vary by patient; it is in the best interest of both patients and physicians to deliver high-quality test results that will meet the analytic precision required in a variety of specific circumstances. Taken in context, attention to clinical laboratory analytic performance is not esoteric, but is rather an integral part of good patient care.

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