Ámbito interno de las Administraciones Públicas

diagnostics

Regional multi-disciplinary centers for hemato-oncology diagnosis are the ideal model for the full assessment of hematological malignancies and com-pliance with the WHO classification. There are many advantages for patients and clinicians, primarily in quality (Table 6.1). This approach supports excellence in patient care, teaching and research and is cost-effective, patient-focused and efficient. It provides a critical mass of scientific and medical expertise which is available to a large number of patients, many of whom would not otherwise benefit from such profi-ciency. A significant benefit is therefore an equitable

service for patients, irrespective of their geographical location within a region. Inter-regional collaborations are more easily achieved and will support national and international networks. Centralized diagnostic facilities are better able to respond to new demands, be they clinical, scientific (e.g. introduction of new investigations), political or economic, and should be sustainable. However, the major gains are the ability to integrate results of all tests performed, generate a pathology report of clinical relevance and commu-nicate information to clinicians. This is a patient-focused approach from which clinical benefits will inevitably follow.

There are a number of requirements that must be met for integrated services to be a success (Table 6.5).

There must be a major commitment from clinician users, scientific staff and funders to centralize testing, and a guarantee that the information technology requirements will be met. Without these the clinical advantages will be difficult to achieve. There are eco-nomic implications with initial capital investment, staffing and ongoing running costs. However, this is offset by the clinical advantages, savings in critical mass and equity of access.

The extent of testing and ability to meet all WHO criteria may be dependent on the financial resources and medical and scientific skills available.

It may not be possible, for example, to provide a complete test repertoire, specifically in resource-poor countries. It is already acknowledged that molecular techniques are not readily available in some

Table 6.5. Requirements for a regional hemato-oncology diagnostic service.

Commitment from users and funders to centralize testing and integrate data

Regional cooperation and coordination

Medical and scientific expertise in hemato-oncology diagnosis Transport systems for specimen delivery

Appropriate equipment and other technical resources Financial support

Excellent communication with referring centers, including regular team meetings

Information technology systems and support for rapid provision of results

Commitment to education and training

jurisdictions due to restricted facilities, and, in others, advanced scientific technologies may be available without ready access to skilled personnel [31]. International networks and collaborations between large diagnostic facilities should be able to address some of these limitations.

Conclusion

Integrated hemato-oncology diagnostic testing and reporting ensures the most accurate diagnosis is achieved for as large a patient population as possible, in a timely and cost-effective manner. Such multi-disciplinary laboratories have proved their advantages for clinicians and their patients: they are efficient, generate accurate results, are scientifically robust and meet clinical needs and the WHO diagnostic requirements. They also give a platform to provide rapid responses to technological change and for serv-ice development. Integrated diagnostic laboratories should be the standard of care for the diagnosis of hematological malignancies.

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