Clinical pathology laboratories in the city of Sao Paulo: analysis of factors that influence performance

Laboratórios de parasitologia clínica na cidade de São Paulo: análise de fatores que influenciam seu desempenho

SUMMARY OF THESIS¹

CASTILHO, Vera Lucia Pagliusi - Laboratórios de parasitologia clínica na cidade de São Paulo: análise de fatores que influenciam seu desempenho. São Paulo, 2002. (Tese de Doutorado - Faculdade de Medicina da Universidade de São Paulo).

CLINICAL PATHOLOGY LABORATORIES IN THE CITY OF SAO PAULO: ANALYSIS OF FACTORS THAT INFLUENCE PERFORMANCE

The status of 132 parasitology labs (LCPs) in the city of Sao Paulo was described and analyzed between 2001 and 2002, focusing on their performance aspects regarding geographical location, size, hospital, public/philanthropic or university type, and compliance with quality control programs.

Data from the LCPs were obtained from a standardized and self-answered questionnaire, which the researchers sent to the labs by mail. A new score to assess the quality of clinical laboratories was also proposed, taking into account several variables that can interfere with the presumed quality of the lab test results.

The laboratory profiles showed that 42.4% are located in a hospital facility, 68.2% are private labs, 31.8% are public/philanthropic labs, and 6.1% are linked to university hospitals.

The location of LCPs in Sao Paulo showed to be associated to the average time of test result reports emission, (p < 0.04), which was lower in the labs located in "Nucleo de Saude" (Health Sector) 5.

Around 2/3 of LCPs in Sao Paulo located in hospitals are also public/philanthropic ones (p < 0.001), of larger size (p < 0.03) and university-related (p < 0.019). Furthermore, they perform a larger number of tests.

LCPs located in universities perform the larger number of tests (p < 0.001) and consequently are larger (p < 0.001), have a larger number of employees, (p < 0.001) and more frequently have physicians among their employees (p < 0.004). Regarding techniques used in the execution of the parasitological exam, there is a larger number of them (p < 0.003) and they appear more often listed among the ones classified as complex techniques (p < 0.031). They also have the longest training hours for new employees (p < 0.04).

Public/philanthropic labs, when compared to private ones, perform the largest number of tests (p < 0.005) and have more professionals working there (p < 0.016).

Clinical parasitology labs with implemented quality control systems and certified by NBR norms of the ISO 9000 series, present a difference in the monthly production of CL (larger number of exams, p < 0.004), have a higher productivity (p < 0.003), more professionals (p < 0.038), more often have training programs for new employees (p < 0.008) and participate more often in interlaboratory proficiency programs (p < 0.003).

The participation in interlaboratory proficiency programs differentiates the LCPs from the other labs due to a larger number of parasitology exams performed (p < 0.004) and a larger number of exams in the CL (p < 0.009), more continuous internal quality control (p < 0.03), more productivity (p < 0.001) and training programs for new employees (p < 0.007). It is noteworthy the association between LCPs certified by ISO 9000 NBR and the participants of interlaboratory proficiency assays (p < 0.003).

Large labs have more productivity (p < 0.009), a larger number of professionals at work (p < 0.001), perform a larger number of diagnostic techniques (p < 0.001) and employ complex techniques more often (p < 0.003). They also provide training programs to new employees more assiduously (p < 0.002), as well as longer training periods (p < 0.04). They participate more often in interlaboratory proficiency programs (p < 0.001), are more frequently certified by the Quality System of ISO 9000 NBR (p < 0.03) and perform internal quality control more frequently (p < 0.017).

Regarding performance in the proposed quality score, we can conclude that large LCPs located in universities that adhere to interlaboratory proficiency programs or have ISO 9000 NBR certification showed to be individually associated to a better performance in the proposed quality score.

Finally, at the multivariate analysis of the determinant variables of the proposed quality score performance, the only category independently associated to a better performance is the university LCP.

Dra. Vera Lucia Pagliusi Castilho

E-mail: [e-mail]

1

This thesis is available at the Library of the Instituto de Medicina Tropical de São Paulo

Publication Dates

• Publication in this collection
  12 Dec 2006
• Date of issue
  Apr 2003