quality:corruption
Laboratory-based surveillance

Laboratory registries allow for the analysis of the incidence and prevalence of the target condition as well as trends in the level of control. For instance, an NIH -funded program called the Vermedx Diabetes Information System maintained a registry of laboratory values of diabetic adults in Vermont and northern New York State in the US with several years of laboratory results on thousands of patients. The data included measures of blood sugar control (glycated hemoglobin A1c), cholesterol, and kidney function (serum creatinine and urine protein), and were used to monitor the quality of care at the patient, practice, and population levels. Since the data contained each patient's name and address, the system was also used to communicate directly with patients when the laboratory data indicated the need for attention. Out of control test results generated a letter to the patient suggesting they take action with their medical provider. Tests that were overdue generated reminders to have testing performed. The system also generated reminders and alerts with guideline-based advice for the practice as well as a periodic roster of each provider's patients and a report card summarizing the health status of the population. Clinical and economic evaluations of the system, including a large randomized clinical trial, demonstrated improvements in adherence to practice guidelines and reductions in the need for emergency department and hospital services as well as total costs per patient. The system has been commercialized and distributed to physicians, insurers, employers and others responsible for the care of chronically ill patients. It is now being expanded to other conditions such as chronic kidney disease.