![]() Using these criteria as a guide, the PLUGS informatics subcommittee identified more than 20 potential metric targets. ![]() Third, the metric needed to enable a laboratory to create a single calculated value from the collected data that was simple enough to be managed in readily available software such as Microsoft Excel. Second, the subcommittee wanted metrics defined by discreet data that could be extracted from a laboratory-based data warehouse, such as a laboratory’s local laboratory information system (LIS). Common opportunities were based on the subcommittee’s expertise and experience, as well as review of published literature or other clinical evidence-based guidelines. First, it needed to be a common opportunity for utilization efforts. The ideal metric needed to meet three basic criteria. The first task for the PLUGS informatics subcommittee was to identify a set of metrics to develop. PLUGS (Patient-Centered Laboratory Utilization Guidance Services) has created an Informatics Tools Working Group to address this gap. Second, gathering, collating, and sharing data with participants is resource intensive. First, the laboratory will need to account for differences in patient population (e.g., pediatrics, inpatient, community practice). When evaluating a practice against a benchmark based on peer data, as opposed to an evidence-based practice standard, there are two important considerations. Another study established benchmarks based on Choosing Wisely recommendations using common lab tests (e.g., sodium) to normalize for comparison ( 3). In one example, Signorelli, et al., examined vitamin D ordering across 30 institutions to demonstrate practice variation and found that the mean ratio of 1,25 dihydroxyvitamin D to 25 hydroxyvitamin D was 1:18 (2). The literature is relatively sparse, with only a few examples demonstrating this approach for laboratory stewardship. Using this technique, an institution compares its performance against peers or a recognized best practice. Institutions can use benchmarking to determine the best opportunities for improving stewardship. However, the complexities of our current healthcare system can make this vision feel overwhelming or unattainable, even for the most advanced laboratory stewardship programs. It takes an administrative staff that shares our lawyers’ commitment to quality and excellence.M any institutions have laboratory stewardship programs that aim to improve ordering, retrieval, and interpretation of laboratory tests, while also developing and maintaining systems to provide appropriate financial coverage ( 1). It takes more than great lawyers to make a great law firm. Yet, all share important qualities-intelligence, creativity, energy, dedication and a commitment to excellence. There is no Cravath “type.” Our lawyers represent a wide range of backgrounds and interests. Each of our departments is recognized as among the finest in the world. Our goal is to be the firm of choice for clients with respect to their most challenging legal issues, most significant business transactions and most critical disputes. We are not, and do not strive to be, the largest law firm measured by number of offices or lawyers. Throughout our history, we have played a central role in developing how law is practiced, how lawyers are trained and how business risk is managed. Each of our practice areas is highly regarded, and our lawyers are recognized around the world for their commitment to the representation of our clients’ interests. Cravath has been known as one of the premier U.S.
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