Journal List > Ann Clin Microbiol > v.16(2) > 1078491

Kim, Sung, Park, and Chang: A Proposal for Laboratory Workflow Changes for Efficient Tuberculosis Control

초록

There are several problems in mycobacterial detection and drug susceptibility testing. One problem is that some test results are unnecessarily delayed because the tests are postponed until patients revisit clinics and pay the cost of the tests. Another problem is that critical and important tests are not re-quested because patients do not agree with their necessity. These inefficient practices may be due to the fee-for-service policy that the Korean medical insurance system is adopting and because many test methods used for mycobacterial infection have each test codes. Therefore, we propose a new test code encompassing several test items necessary for laboratory diagnosis of mycobacterial infection. This new code enables all necessary tests to be performed se-quentially without delay and also prevents perform-ance of unnecessary tests. These changes will help control tuberculosis without any further medical insurance financial input.

REFERENCES

1.World Health Organization. Global tuberculosis report 2012. Publication No. WHO/HTM/TB/2012.6.http://www.who.int/tb/publi-cations/global_report/en/index.html. [Online] (last visited on 15 May 2013).
2.Korean Hospital Association. Geongang Boheom Yoyang Geubyeo Biyong. Korean Hospital Association. 2013.
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4.Joint Committee for the Development of Korean Guidelines for Tuberculosis, and Korea Centers for Disease Control and Prevention. 2011. Korea Guidelines for Tuberculosis.http://www.lungkorea.org/thesis/file/%B0%E1%C7%D9%C1%F8%B7%E1%C1%F6%C4%A7-%-C3%D6%C1%BE20110608.pdf. [Online] (last visited on 15 May 2013).
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Fig. 1.
The workflow of laboratory tests for the diagnosis of tuberculosis or other mycobacterial infection. (A) current status, and (B) suggestion of workflow changes. Abbreviations: MTB, Mycobacterium tuberculosis; NTM, nontuberculous mycobacteria; AST, antibiotic susceptibility test; MAC, Mycobacterium avium complex; RGM, rapidly growing mycobacteria.
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Fig. 1.
Continued.
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Table 1.
Test codes and their reimbursement prices for detecting mycobacteria and drug susceptibility
Test codes Test names Price codes Scores Prices
Na-400 Microscopic examination for microorganism [routine]      
Da. Direct AFB stain B4105 19.61 1,320
Ra. Acid fast stain B4120 49.86 3,370
Na-402 Microscopic examination for microorganism [fluorescence, dark field microscopy] B4021 46.52 3,140
Na-405 Microorganism culture and identification      
Na. AFB culture and identification      
  (1) Solid media B4054 192.40 12,990
  (2) Liquid media B4055 256.11 17,290
Na-406 Microorganism antibiotic sensitivity test      
Da. AFB antibiotics sensitivity test      
  (1) Less than 10 drugs B4063 188.35 12,710
  (2) 10 drugs or more B4064 564.43 38,100
Note: Liquid medium culture (regardless no. of drugs) B4065 301.58 20,360
Neo-304 Acid fast fluorescent stain BX304 75.33 5,080
Neo-595 Polymerase chain reaction      
Da. Mycobacterium tuberculosis C5953 370.05 24,980
Neo-595-1 PCR-hybridization      
Ga. Mycobacterium tuberculosis C6021 611.52 41,280
Na. Mycobacterium tuberculosis drug resistance      
  (1) Rifampicin CY751 580.21 39,160
  (2) Isoniazid CY752 580.21 39,160
Neo-562 PCR-RFLP      
Neo. Nontuberculous mycobacteria identification test CY636 455.60 30,750
Neo-563 Nested PCR      
Ga. Mycobacterium tuberculosis CY051 541.11 36,520
No-598 Other tests      
Ra. Mycobacterium tuberculosis drug resistance (DNA sequencing)      
  (1) Pyrazinamide CZ962    
  (2) Isoniazid CZ985 Not covered by the medical
  (3) Rifampicin CZ986 insurance
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