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K M Peddecord

Publications and source records attributed to K M Peddecord.

At least 19 recordsLinked to original sources
PubMed1996

Quality perceptions of microbiology services. A survey of infectious diseases specialists.

Opinions about the quality of their primary microbiology laboratory were received from more than 500 practicing infectious diseases specialists by a nationally distributed questionnaire. Approximately 92% of the respondents' primary laboratories were hospital-based. These sophisticated users rated the quality of their microbiology laboratories to be generally high, with bacteriology receiving highest scores and parasitology the lowest scores. Fortunately, the serious problems, such as failing to call a critical result and culture mishandled in the laboratory, were experienced rarely. Laboratories directed by pathologists with specialty microbiology training, PHD microbiologists, and infectious diseases specialists were judged to be of highest quality. American Board of Medical Microbiology certification of the laboratory director was related to higher overall quality perceptions. Whereas physician-customer opinions may not directly measure a laboratory's analytic quality, they are an important performance measure on which laboratories can base quality improvement activities in both service and analytical aspects of performance.

Clinical Laboratory Techniques↗
PubMed1996

Physician satisfaction with human immunodeficiency virus type 1 and hepatitis B virus testing in San Diego County.

Physician satisfaction with the laboratory testing process is one indicator of the physician's perception of the quality of laboratory testing and the effectiveness of the communication of the laboratory results. This study compares the level of satisfaction of physicians reporting their experience with human immunodeficiency virus type 1 (HIV-1) testing with the satisfaction levels of those physicians reporting their experience with hepatitis B virus (HBV) testing. By mail, 6,570 licensed San Diego County physicians were surveyed. Among those who tested for HIV-1 or HBV, their satisfaction with four different HIV-1 or HBV testing parameters was assessed: 1) specimen submission process, 2) test accuracy, 3) clarity of test report, and 4) turnaround time. Overall, physician satisfaction with both HIV-1 and HBV testing was high, particularly for test accuracy (means of 2.79 and 2.84, respectively on a 3-point scale), although slightly lower for turnaround time (means of 2.40 and 2.43, respectively). Mean satisfaction with the specimen submission process and test accuracy were higher for physicians who ordered HBV tests than for those who ordered HIV-1 tests. Satisfaction with the four HIV-1 testing process parameters varied significantly by physician specialty, practice type, and type of laboratory used. For HBV testing, significant differences were observed only for turnaround time. For both HIV-1 and HBV testing, those who received a final interpretation of laboratory results were more satisfied with test report clarity than those who did not. Although physician satisfaction with HIV-1 and HBV testing is high, this study identifies the least satisfied groups and specific areas in the testing process than may need improvement.

AIDS Serodiagnosis↗
PubMed1996

Infectious disease physicians rate microbiology services and practices.

Recent years have seen increasing emphasis on cost containment and quality improvement in clinical laboratory activities. Modifying those activities to enhance clinical relevance is one strategy that should be satisfying to both laboratory scientists and administrators. This guest commentary describes one approach to quality improvement--the use of user surveys to identify areas for improvement. As an initial attempt to define such areas in clinical diagnostic microbiology, infectious disease specialists, targeted for their particular interest and expertise in microbiology laboratory results, were polled and their responses were analyzed. Some of these data have been presented previously (E. J. Baron, D. P. Francis, and K. M. Peddecord, abstr. C-170, p. 520, in Abstracts of the 94th General Meeting of the American Society for Microbiology, 1994; K. M. Peddecord, E. J. Baron, D. P. Francis, and A. S. Benenson, abstr. C-172, p. 520, in Abstracts of the 94th General Meeting of the American Society for Microbiology, 1994; K. M. Peddecord, E. J. Baron, D. P. Francis, and J. A. Drew, Am. J. Clin. Pathol. 105:58-64, 1996). The discussion includes our recommendations for the use of these survey responses, and their limitations, as stimuli to initiate reexamination of certain microbiology laboratory practices in the interest of developing more cost-effective and clinically relevant protocols.

Bacteremia↗
PubMed1996

A critical review of personnel standards.

Qualified personnel are necessary to ensure quality results, but there is no evidence on what minimal educational requirements are necessary. In the future, cost-effectiveness analysis may be useful for policy questions such as the utility of personnel regulations. CLIA '88 regulations require explicit assessment of personnel competency. Survey evidence suggests that previously regulated laboratories tend to have highly formalized competency assessment programs, while physician office laboratory programs are minimal. Responding laboratory supervisors had no uniform definition of competency, but technical abilities, productivity, and professionalism were regarded as essential. Suggestions for contemporary strategies by laboratory professionals and their organizations in the current increasingly competitive managed care environment are described. Faced with limited empirical evidence on personnel, laboratory directors and supervisors should focus on the total testing process, the needs of clinicians, and the uses of testing information to guide personnel assignments.

Cost-Benefit Analysis↗
PubMed1993

Variability of reporting and lack of adherence to consensus guidelines in human T-lymphocyte immunophenotyping reports: results of a case series.

Percentages and absolute counts of CD4+ lymphocytes, as determined by T-lymphocyte immunophenotyping (TLI), are prognostic, as well as diagnostic, of the course of human immunodeficiency virus type 1 infections and are important indicators for initiating Pneumocystis carinii pneumonia prophylaxis and antiretroviral therapy. In December 1990, we requested that a nonrandom sample of 17 laboratories provide us with typical reports of their TLI results from an immunodeficient patient and from a patient whose TLI results were within the laboratory's normal reference ranges. We also searched published literature and documents proposed by professional organizations for recommendations regarding T-lymphocyte testing and reporting. This article compares guidelines for reporting TLI results, as proposed by the National Committee for Clinical Laboratory Standards in Document H42-P, with samples of reports obtained in our case series. Most reports follow some, but not all, of the proposed guidelines. A majority of the laboratories provided interpretations of the results in their reports. We found considerable variation in normal reference ranges. We describe this variation in detail for the CD4+ T-lymphocyte counts and CD4+ T-lymphocyte percentages. This article describes some of the TLI result report forms currently being used and identifies important quality issues in this rapidly expanding area of clinical laboratory testing.

Forms and Records Control↗
PubMed1992

Content and design of laboratory report forms for human immunodeficiency virus type 1 antibody testing.

In a pilot study involving proficiency testing for human immunodeficiency virus, markedly diverse and potentially confusing test report forms were encountered among participating laboratories. Therefore, a comprehensive study of human immunodeficiency virus type 1 report forms was conducted from state-licensed testing laboratories in California. Participants analyzed three serum samples of known human immunodeficiency virus type 1 antibody reactivity and reported their results on forms that they would normally submit to clinicians. Report forms from 84 laboratories were evaluated for content, design, and clarity. Differences were found among commercial, hospital, and public health laboratories. The significance of these findings is discussed. This technique also may be applied to evaluate laboratory report form design and content for other diagnostic test results.

AIDS Serodiagnosis↗
PubMed1991

The laboratory diagnosis of HIV infection.

Testing for HIV is a procedure with possible dire consequences; hence, reports should not be rendered to the patient without appropriate counseling. And this must be based on firm information whether the individual is truly infected if the report is positive. The reactive results of the EIA screening test should always be confirmed by supplemental testing. However, it must be remembered that a nonreactive serum does not exclude the possibility of the individual being infected; only by additional research studies, such as the polymerase chain reaction, can one be sure that the patient is not in the phase in which antibodies have not yet developed but the virus is present and the patient can transmit the infection. Our studies have found that the accuracy of testing HIV serum specimens is excellent. The biggest problem may be the potential confusion caused by the laboratory reports. All clinicians (nurses, educators, and physicians) who counsel or test potential HIV patients must be sure that they understand their laboratory's report. If there is any doubt about the report content, it must be clarified by contacting the laboratory director. The results of HIV antibody testing are so important to the patient that the significance of the report must be crystal clear to the counselor and any possible ambiguity clarified.

AIDS Serodiagnosis↗
PubMed1990

Prevalence of alcohol consumption among older persons.

Percent prevalences of alcohol consumption were determined in a cross-sectional study of randomly chosen residents of San Diego County, California aged 45 years and over. The study sample (N = 2,105) showed statistically significant drinking differences between Whites (n = 819), Blacks (n = 629), and Mexican-Americans (n = 657). Overall, the highest prevalence of drinking occurred among the White elderly. The common belief that socioeconomic conditions are inversely associated with a high prevalence of drinking was not supported in this sample. Statistically significant differences in age-specific and sex-specific percent prevalences of alcohol intake were also found. There was a generally decreasing prevalence of alcohol consumption with advancing age, which existed regardless of ethnicity. Initial empirical measures and a better understanding of drinking correlates will identify those elderly persons at risk and provide the basis for future interventions in the areas of applied epidemiology and health promotion.

Black or African American↗
PubMed1990

Clinical laboratory regulation under the Clinical Laboratory Improvement Amendments of 1988: can it be done?

This report examines logical but not yet widely recognized ramifications of the Clinical Laboratory Improvement Amendments of 1988 (CLIA'88), federal legislation that will require certification of all laboratories examining human specimens. Examination of the CLIA'88 committee reports and committee hearings suggest that more than the conventional approach to laboratory standards will be needed to meet the public's expectations as articulated by our elected representatives. The conventional approach to clinical testing standards seeks to assure quality by regulating the laboratory analytical process. However, little empirical evidence is available to support or refute this model, which has been used during the past 25 years. One alternative paradigm for laboratory standards is an approach that examines the total laboratory testing process, including the selection, ordering, and interpretation of the test as well as the laboratory analysis per se. The history of controversy over laboratory standards--especially personnel standards, the glacial federal regulatory rulemaking process, public expectations of fail-safe technology, among other factors--suggests the implementation of CLIA'88 will be a lengthy and vigorously debated contest. The risk of a test is seldom inherent in the test itself, but rather is a function of the context in which the test is being used to provide information for medical decision making. Our premise is that diagnostic tests must be examined in the context of the laboratory testing situation. We suggest that now is the appropriate time for laboratory professionals, practicing physicians, and the public to abandon conventional thinking regarding clinical laboratory standards. We believe that CLIA'88 reflects a shift in public expectations toward fail-safe laboratory testing and the need for additional government oversight in laboratory test quality. If these new expectations persist, CLIA'88 represents a potential landmark in the course of federal authority and the practice of medicine in the United States.

Humans↗
PubMed1990

A discriminant analysis of severe alcohol consumption among older persons.

A cross-sectional study among older persons (N = 1034) utilized multivariate stepwise discriminate analysis to determine the predictive value of variables affecting alcohol intake. Fifteen per cent of our study sample was classified as severe drinkers. Alcohol consumption before age 40, smoking, male gender and marital status were predictors of severe drinking. In addition, the unimpaired Older Americans Resource and Services (OARS) objective summary ratings for physical status and activities of daily living (ADL) were associated with severe drinking. Assessing the factors that predict alcohol consumption may help to identify initially those persons at possible risk, lending to heuristic and theoretical alcohol prevention policies among the aged.

Activities of Daily Living↗
PubMed1989

A regulatory model for clinical laboratories: an empirical evaluation.

Clinical laboratories in the United States are subject to various regulatory and accreditation programs, which mandate a broad range of requirements regarding personnel, quality-control systems, and analytical proficiency standards. Reported here, for a cross-section of U.S. laboratories, is the degree of compliance with these regulatory requirements, some other laboratory characteristics, and their relation to analytical proficiency. The results suggest that those laboratory characteristics that predict highest proficiency-test performance differ for each laboratory specialty. Regression models are presented that explain from 12% to 35% of the variation in analytical performance and suggest that factors outside of those specified in the regulatory model and other characteristics measured in this research are important. Indeed, the current regulatory approach may not ensure highest performance. Also discussed are the current status, limitations, and prospects for change of the clinical laboratory regulatory system.

Accreditation↗
PubMed1988

Substitution of magnetic resonance imaging for computed tomography. An exploratory study.

Despite the importance of understanding factors related to physician adoption and use of diagnostic technologies, relatively few studies have been published. Results of a two-year study of the adoption of magnetic resonance imaging (MRI) and its substitution for computed tomography scanning (CT) are presented. The literature on physician adoption and use of technology is used to provide a framework for this study. Differences in adoption and substitution among medical specialties, early versus late adopters, and high versus low users of MRI are examined. Results show that neurologists and internists more rapidly adopt MRI and substitute it for CT than do orthopedists and other surgical specialists. Referral of higher numbers of patients is the best predictor of more rapid substitution. Physicians who were late adopters more quickly substituted MRI for CT. The cost and social implications of empirical versus "ideal" substitution rates are discussed along with how various regulatory, technology assessment, and financial strategies influence substitution. The role of individual physicians, radiologists, and specialty societies in determining substitution rates is also discussed.

California↗
PubMed1987

Use of MR imaging in an outpatient MR center.

Indications for MR examinations and patient characteristics are evaluated for 4561 MR examinations performed at a freestanding outpatient MR imaging center between May 1984 and June 1986. Hospitalized patients accounted for less than 3% of the case load. Examinations of the head and spine accounted for 60% and 31% of the work load, respectively. Patients 65 years or older made up 15% of the case load during 1984 and 1985 and 21% in 1986. Referrals from neurologists, internists, and neurosurgeons accounted for 56%, 11% and 9% of patients, respectively. The percentage of patients who had CT, myelography, and other imaging procedures performed before referral for MR imaging declined significantly between 1984 and 1986. Indications for examination were mostly neoplastic diseases; degenerative diseases of the CNS, including multiple sclerosis; other disorders of the CNS; and disk diseases. Approximately 40% of all examinations were interpreted as normal. The number of patients referred for degenerative intervertebral disk disorders increased substantially between 1984 and 1985. This study documents the increasing acceptance of MR imaging as an important primary imaging technique for a variety of conditions, particularly those of the brain and spine.

Aged↗
PubMed1986

The association between cerebrovascular disease and smoking: a case-control study.

A retrospective case-control study was carried out to examine the relationship between cigarette smoking and cerebrovascular disease occurrence. Cases were obtained from the University of California-American Heart Association, San Diego Stroke Data Bank, and controls from selected Veterans Administration and University of California, San Diego, outpatient departments. When cigarette smoking was dichotomously coded into categories of low and high lifetime exposure, consistent significant positive associations were found with cerebrovascular disease occurrence in both bivariate and multivariate analysis when controlling for blood pressure. These associations, however, were not found when smoking was categorized as smoker, ex-smoker, and non-smoker. No association was found between passive smoking and cerebrovascular disease. The results indicate that a cumulative lifetime exposure to active cigarette smoking is directly associated with cerebrovascular disease.

Blood Pressure↗
PubMed1985

Education, training, professional certification, and work patterns of directors in interstate laboratories.

Education, professional training, certification, and work patterns of 988 laboratory directors employed in 440 clinical laboratories licensed under the Clinical Laboratories Improvement Act of 1967 are examined. Directors of hospital laboratories as opposed to independent laboratories were more likely to be physicians (82.8% vs. 68.0%), to have completed a formal residency program (75.5% vs. 62.0%), and to be certified in both anatomic and clinical pathology (65.3% vs. 57.1%). Only 51.9% of pathologists confined their work to a single laboratory, while 64.8% of directors with Ph.D.s or other doctorates directed only one laboratory. Most laboratories (81.5%) have at least one associate director. Hospital directors are more often full time (30 or more hours per week) than their independent laboratory counterparts, 74.4% vs. 42.4%, respectively. When the education and experience of individuals entering the field between the 1950s and 1970s are examined, it is evident that fewer individuals with bachelor's or master's degrees now are able to qualify as laboratory directors.

Certification↗
PubMed1985

The relationship of hospital ownership and service composition to hospital charges.

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals.

Analysis of Variance↗