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Enhancing Hemoglobin A1c Analysis for Bowdoin Street Health Center
The Results/Progress to Date
The Problem
Individuals with diabetes have an increased risk of developing retinopathy and neuropathy, as well as
increased long‐term risks of cardiovascular and kidney disease. The Hemoglobin A1c (HbA1c) laboratory
test assesses long‐term glycemic control over a period of 2 to 3 months by measuring the degree of
hemoglobin glycation and also allows for the calculation of the estimated average glucose (eAG)
concentration. The American Diabetes Association recommends that clinicians test diabetic patients for
HbA1c at least every 6 months in an effort to improve glycemic control outcomes. Monitoring levels
twice annually is also required to meet compliance guidelines for pay‐for‐performance payment models.
Laboratory Medicine validated the Afinion™ analyzer against the Roche Integra immunoassay method
(Clinical Chemistry Laboratory) in August 2013. The manufacturer’s reportable range was validated
from 4.0 – 15.0% HbA1c.
Samples with known HbS (red) and HbC (green) variants were included in the validation and showed
acceptable correlation without any interference.
Bowdoin Street Health Center staff members were trained to operate the analyzer and documented
competency by comparing finger stick samples to venipuncture samples in October 2013.
Aim/Goal
Scheduled visits with the healthcare provider to outline and assess individualized treatment plans are
thought to improve patient outcomes. In addition, access to an instrument that utilizes a finger stick
sample in the clinical setting would allow the provider to obtain HbA1c in real‐time and less invasively.
Immediate results also impact workflow in reducing the need for follow‐up calls and return patient visits.
Both patients and clinicians are reluctant to have blood collected by venipuncture; preferring instead
finger stick samples. The ability to perform the HbA1c test in the clinical setting, at the point of care
(POC) with a finger stick sample is thought to improve management of diabetic patients by allowing real
time interventions while the patients are meeting with the provider.
The Team
Bowdoin Street Health Center
Laboratory Medicine
Harvey Bidwell, MD
Adela Margules
Fran Azzara, RN
Rose O’Brien, RN
Maria Perez
Lynne Uhl, MD
Gary Horowitz, MD
Nicole Tolan, PhD
Gina McCormack
Avril Jean‐Noel
Bernadine Williams
The Interventions
A review of CLIA Waived HbA1c analyzers was conducted by Laboratory Medicine because several
methods are known to have interferences from hemoglobin variants. Given the diverse patient
population, it is important to be able to obtain a result without interference from these variants.
The Alere Afinion™ AS100 Hemoglobin A1c POC analyzer method is certified by the National
Glycohemoglobin Standardization Program (NGSP) and is standardized to the Diabetes Control and
Complications Trial (DCCT) assay.
The method is reported to have no interference from the following hemoglobin variants: HbC, HbD,
HbE, HbF, HbJ, and HbS.
This method allows finger stick samples (sample size 1.5 l of whole blood) to be used in place of
venipuncture and gives HbA1c results within 3 minutes.
Bowdoin Street Health Center has replaced venipuncture for HbA1c with finger stick samples. In the
month of January, 90 samples were tested – averaging 4 samples per day.
Increased efficiency for clinicians and office staff by improving the test turn‐around‐time. Samples are
no longer sent to the main lab where results are available the next day; eliminating the need for call‐
backs and follow‐up visits.
Overall, replacing off‐site laboratory HbA1c measurement with POCT has increased clinician and
patient satisfaction.
Lessons Learned
Initiatives that change existing care practices can significantly improve patient care and outcomes, but
require carefully planned multi‐disciplinary and multi‐departmental collaboration.
Next Steps/What Should Happen Next
Implementation of a second Afinion™ analyzer at Bowdoin Street and assist MCCN Chelsea with the
validation of the Afinion ™ analyzer for their clinic.
POCT may allow for better compliance with pay‐for‐performance guidelines. Evaluation of the number
of HbA1c measurements for each patient will capture the potential improvement.
Real time HbA1c results have been reported to improve the clinician/patient interaction by allowing
clinicians to counsel their patients face‐to‐face. This may result in better patient understanding,
compliance, and improved outcomes. Long‐term, review of HbA1c patient‐specific means will
determine efficacy of POCT to reduce HbA1c and improve glycemic control.
For more information, contact:
Avril Jean-Noel, POC Specialist ajean@bidmc.harvard.edu
Bernadine Williams, POC Specialist bwillia2@bidmc.harvard.edu
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Dublin Core
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Bernadine Williams (<a href="mailto:bwillia2@bidmc.harvard.edu">bwillia2@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Laboratory Medicine
Bowdoin Street Health Center
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Harvey Bidwell<br />Lynne Uhl<br />Adela Margules<br /> Gary Horowitz<br />Fran Azzara<br />Nicole Tolan<br />Rose O’Brien<br />Gina McCormack <br />Maria Perez <br />Avril Jean‐Noel <br />Bernadine Williams
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Enhancing Hemoglobin A1c Analysis for Bowdoin Street Health Center
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency