Abstract
OBJECTIVES: The objectives of this article are (a) to identify current deficiencies in performance evaluation for which there are proven solutions that will improve clinical decision-making; (b) to prioritize useful initiatives, such as noninvasive monitoring, for resiliency in low-resource countries and island nations; and (c) to introduce the concept of "point of care (POC) culture." METHODS: The following methods were employed: cultural factors analysis from Peace Corps experiences; Cambodia data collection; POC status in ASEAN-member states; country needs surveys, past and present; a new local nonparametric method (locally smoothed median absolute difference and maximum absolute difference curves) for performance standardization; and geographical information systems and mobile knowledge optimizers. RESULTS: Needs for POC testing in low-resource settings are striking. Often, POC testing is used in lieu of diagnostic testing in hospital laboratories, because conventional services may be too distant, prohibitively costly, or simply unavailable. Locally-smoothed median absolute difference and maximum absolute difference curves enable method fidelity. Rapid testing directly at the site of care represents a unique resource for screening, diagnosis, monitoring, and treatment. CONCLUSIONS: Integrative initiatives, such as the new consensus national guideline in Malaysia and the International Federation for Clinical Chemistry Task Force on POC Testing and its working groups started in 2012, are vital for addressing leadership and management challenges in nations adapting to increasing populations of both young and old persons, despite striking scarcity of resources. Global harmonization of POC performance will accelerate progress in these countries by improving the quality, usefulness, and impact of decision-making. Worldwide outreach and culturally sensitive POC strategies in small-world networks will enhance standards of care, including crisis standards of care during public health pandemics, complex emergencies, and natural disasters.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-8 |
| Number of pages | 8 |
| Journal | Point of Care |
| Volume | 12 |
| Issue number | 1 |
| DOIs | |
| State | Published - Mar 2013 |
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Keywords
- and standardization
- ASEAN
- fidelity
- global positioning system
- hemoglobin monitoring
- island nation
- knowledge optimizer
- locally smoothed (LS) median absolute difference (MAD)
- low-resource country
- maximum absolute difference (MaxAD)
- noninvasive continuous monitoring
- oxygen saturation
- pulse oximeter
- sociology
ASJC Scopus subject areas
- Nursing(all)
Cite this
The final frontier for point of care : Performance, resilience, and culture. / Kost, Gerald J; Katip, Pratheep; Vansith, Ket; Negash, Henok.
In: Point of Care, Vol. 12, No. 1, 03.2013, p. 1-8.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The final frontier for point of care
T2 - Performance, resilience, and culture
AU - Kost, Gerald J
AU - Katip, Pratheep
AU - Vansith, Ket
AU - Negash, Henok
PY - 2013/3
Y1 - 2013/3
N2 - OBJECTIVES: The objectives of this article are (a) to identify current deficiencies in performance evaluation for which there are proven solutions that will improve clinical decision-making; (b) to prioritize useful initiatives, such as noninvasive monitoring, for resiliency in low-resource countries and island nations; and (c) to introduce the concept of "point of care (POC) culture." METHODS: The following methods were employed: cultural factors analysis from Peace Corps experiences; Cambodia data collection; POC status in ASEAN-member states; country needs surveys, past and present; a new local nonparametric method (locally smoothed median absolute difference and maximum absolute difference curves) for performance standardization; and geographical information systems and mobile knowledge optimizers. RESULTS: Needs for POC testing in low-resource settings are striking. Often, POC testing is used in lieu of diagnostic testing in hospital laboratories, because conventional services may be too distant, prohibitively costly, or simply unavailable. Locally-smoothed median absolute difference and maximum absolute difference curves enable method fidelity. Rapid testing directly at the site of care represents a unique resource for screening, diagnosis, monitoring, and treatment. CONCLUSIONS: Integrative initiatives, such as the new consensus national guideline in Malaysia and the International Federation for Clinical Chemistry Task Force on POC Testing and its working groups started in 2012, are vital for addressing leadership and management challenges in nations adapting to increasing populations of both young and old persons, despite striking scarcity of resources. Global harmonization of POC performance will accelerate progress in these countries by improving the quality, usefulness, and impact of decision-making. Worldwide outreach and culturally sensitive POC strategies in small-world networks will enhance standards of care, including crisis standards of care during public health pandemics, complex emergencies, and natural disasters.
AB - OBJECTIVES: The objectives of this article are (a) to identify current deficiencies in performance evaluation for which there are proven solutions that will improve clinical decision-making; (b) to prioritize useful initiatives, such as noninvasive monitoring, for resiliency in low-resource countries and island nations; and (c) to introduce the concept of "point of care (POC) culture." METHODS: The following methods were employed: cultural factors analysis from Peace Corps experiences; Cambodia data collection; POC status in ASEAN-member states; country needs surveys, past and present; a new local nonparametric method (locally smoothed median absolute difference and maximum absolute difference curves) for performance standardization; and geographical information systems and mobile knowledge optimizers. RESULTS: Needs for POC testing in low-resource settings are striking. Often, POC testing is used in lieu of diagnostic testing in hospital laboratories, because conventional services may be too distant, prohibitively costly, or simply unavailable. Locally-smoothed median absolute difference and maximum absolute difference curves enable method fidelity. Rapid testing directly at the site of care represents a unique resource for screening, diagnosis, monitoring, and treatment. CONCLUSIONS: Integrative initiatives, such as the new consensus national guideline in Malaysia and the International Federation for Clinical Chemistry Task Force on POC Testing and its working groups started in 2012, are vital for addressing leadership and management challenges in nations adapting to increasing populations of both young and old persons, despite striking scarcity of resources. Global harmonization of POC performance will accelerate progress in these countries by improving the quality, usefulness, and impact of decision-making. Worldwide outreach and culturally sensitive POC strategies in small-world networks will enhance standards of care, including crisis standards of care during public health pandemics, complex emergencies, and natural disasters.
KW - and standardization
KW - ASEAN
KW - fidelity
KW - global positioning system
KW - hemoglobin monitoring
KW - island nation
KW - knowledge optimizer
KW - locally smoothed (LS) median absolute difference (MAD)
KW - low-resource country
KW - maximum absolute difference (MaxAD)
KW - noninvasive continuous monitoring
KW - oxygen saturation
KW - pulse oximeter
KW - sociology
UR - http://www.scopus.com/inward/record.url?scp=84874950743&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874950743&partnerID=8YFLogxK
U2 - 10.1097/POC.0b013e318266b7fe
DO - 10.1097/POC.0b013e318266b7fe
M3 - Article
AN - SCOPUS:84874950743
VL - 12
SP - 1
EP - 8
JO - Point of Care
JF - Point of Care
SN - 1533-029X
IS - 1
ER -