THE PHYSICIANS OFFICE LABORATORY - 1988 AND 1996 SURVEY OF ILLINOIS PEDIATRICIANS

Objectives: To contrast practices of physicians' office laboratories i n the years 1988 and 1996 and ascertain physicians' perception of the effect of the Clinical laboratory Improvement Amendments of 1988 (CLIA ). Design: Mailed surveys to members of the Illinois chapter of the Am erican Academy of Pediatrics in 1988 and 1996. Subjects: There were 52 5 and 980 respondents in 1988 and 1996, respectively; analyses include d 282 and 374 surveys representing offices where direct patient care w as provided in a nonhospital setting. A paired analysis was also condu cted on 101 offices that responded to both surveys. Results: There was a decline from 1988 to 1996 in the percentage of offices doing in-off ice laboratory testing (93% to 84%, respectively; chi(2) test; P < .01 ) and median number of types of tests (6 tests vs 4 tests; Mann-Whitne y U test; P < .001). Decreases (chi(2) test, P < .01) were seen in the proportion of offices offering throat culture for group A streptococc i (63% to 33%), urinalysis (54% to 33%), urine culture (53% to 22%), r apid hemagglutination slide test for mononucleosis (42% to 17%), theop hylline level (27% to 4%), and total cholesterol (22% to 13%). The pro portion of offices offering urine dipstick, hematocrit or hemoglobin, complete blood cell count, and stool occult blood tests remained stabl e. For solo practitioner offices only, streptococcal antigen detection testing decreased (66% to 39%; chi(2) test; P < .001). Findings in th e paired analyses were similar. In 1996, more offices participated in a formal proficiency testing program (60% vs 11%; chi(2) test; P < .00 1). The CLIA guidelines were deemed responsible for increased document ation (58%), discontinuing 1 or more tests (56%), increased frequency of quality control (50%),joining a proficiency program (40%), and incr eased cost to patients (32%). Conclusions: These surveys provide large -scale data concerning change in office-based laboratories of physicia ns serving children during an 8-year period. Office laboratories reduc ed their menu of tests and enhanced documentation and quality control for the tests that were done. Data like these in multiple specialties over time contribute to a comprehensive picture of the effects of CLIA on office laboratory practices.