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Journal of the American Academy of Dermatology
Volume 36, n° 6
pages 995-998 (juin 1997)
Doi : 10.1016/S0190-9622(97)80285-X
Clinical review

Log-in/log-out time: A quality factor for a reference laboratory—Prolonged times for skin pathology processing in managed care-authorized laboratories
 

Neal S. Penneys, MD, PhD, MBA
 Department of Dermatology, Saint Louis University Health Sciences Center, St. Louis, Missouri, USA 

*Reprint requests: Neal S. Penneys, MD, PhD, MBA, Department of Dermatology, 1402 S. Grand Blvd., St. Louis, MO 63104.
Abstract

Managed care organizations may divert skin biopsy specimens to commercial laboratories selected on a cost basis. Diversion to these laboratories could result in service of decreased quality for the patient and referring physician. Log-in/log-out dates were collected for all specimens submitted to managed care-authorized laboratories either from a university-based clinic or from a private practitioner's office for a period of 18 months and compared with data obtained from a local dermatopathology laboratory. A subgroup of specimens containing inflammatory diagnoses or nondiagnostic changes was also examined. Mean log-in/log-out times were 1.338 days in the dermatopathology laboratory, 6.123 days in managed care-authorized laboratories from the university site, and 7.798 days in managed care-authorized laboratories from a practitioner's office. The differences between the dermatopathology laboratory log-in/log-out times and those of the managed care-authorized laboratories were statistically significant (p < 0.0001). The conclusion from this study is that a quality indicator defined as time from log in to log out revealed a significant increase in interpretation time at managed care-designated laboratories. Although managed care plans can decrease their financial risk by contracting with national laboratories to provide all services for a set fee, a decreased quality of service can be demonstrated.

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