The final frontier for point of care: Performance, resilience, and culture

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.