Tobin Berger-Cahn, Evan M Shannon, Brian Zunner-Keating, Catherine Weaver, Joshua Lee, Sae Takada, Cullen M Lilley, Imir G Metushi, Omai B Garner
{"title":"Mobile point-of-care testing to improve access to care for people experiencing homelessness and diabetes in Los Angeles.","authors":"Tobin Berger-Cahn, Evan M Shannon, Brian Zunner-Keating, Catherine Weaver, Joshua Lee, Sae Takada, Cullen M Lilley, Imir G Metushi, Omai B Garner","doi":"10.1093/ajcp/aqag107","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the utilization and results of point-of-care (POC) testing performed by the UCLA Health Homeless Healthcare Collaborative (HHC) to identify diagnostic patterns in patients experiencing homelessness (PEH) and specifically those with diabetes to inform future care models.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using electronic health records of PEH who visited HHC mobile units between January 2023 and August 2024. Point-of-care test quantity, timing, and results were assessed. A comprehensive metabolic panel (CMP), blood glucose, and hemoglobin A1c (HbA1c) results were assessed for differences between diabetic and nondiabetic cohorts at initial presentation.</p><p><strong>Results: </strong>Between January 2023 and August 2024, the HHC served 4653 patients, with 836 receiving a POC test (17.97%). During this period, 126 basic metabolic panels, 197 CMPs, 102 COVID-19 antigen tests, 533 glucose tests, 166 HbA1c tests, 87 hemoglobin tests, 80 influenza A and B tests, 22 rapid strep A tests, 119 urinalysis dipstick tests, and 41 urine pregnancy tests were used. Of all tested, 190 (22.73%) received a diabetes International Classification of Diseases code. Within CMP results, mean sodium (139.5 vs 141.1 mmol/L; P < .05) and mean chloride (103.7 vs 105.8 mmol/L; P < .05) were both lower in patients with diabetes. The mean creatinine was not significantly different (0.91 vs 1.06 mg/dL; P = .097).</p><p><strong>Conclusions: </strong>Point-of-care testing provides critical diagnostic data for PEH, particularly those with diabetes, allowing for a clinician to initiate care prior to the development of severe disease. Expanding the test menu to include urinary albumin-to-creatinine ratio screening and creating POC-specific reference intervals is an opportunity for improvement.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 4","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679977/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of clinical pathology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ajcp/aqag107","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PATHOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To evaluate the utilization and results of point-of-care (POC) testing performed by the UCLA Health Homeless Healthcare Collaborative (HHC) to identify diagnostic patterns in patients experiencing homelessness (PEH) and specifically those with diabetes to inform future care models.
Methods: A retrospective cohort study was performed using electronic health records of PEH who visited HHC mobile units between January 2023 and August 2024. Point-of-care test quantity, timing, and results were assessed. A comprehensive metabolic panel (CMP), blood glucose, and hemoglobin A1c (HbA1c) results were assessed for differences between diabetic and nondiabetic cohorts at initial presentation.
Results: Between January 2023 and August 2024, the HHC served 4653 patients, with 836 receiving a POC test (17.97%). During this period, 126 basic metabolic panels, 197 CMPs, 102 COVID-19 antigen tests, 533 glucose tests, 166 HbA1c tests, 87 hemoglobin tests, 80 influenza A and B tests, 22 rapid strep A tests, 119 urinalysis dipstick tests, and 41 urine pregnancy tests were used. Of all tested, 190 (22.73%) received a diabetes International Classification of Diseases code. Within CMP results, mean sodium (139.5 vs 141.1 mmol/L; P < .05) and mean chloride (103.7 vs 105.8 mmol/L; P < .05) were both lower in patients with diabetes. The mean creatinine was not significantly different (0.91 vs 1.06 mg/dL; P = .097).
Conclusions: Point-of-care testing provides critical diagnostic data for PEH, particularly those with diabetes, allowing for a clinician to initiate care prior to the development of severe disease. Expanding the test menu to include urinary albumin-to-creatinine ratio screening and creating POC-specific reference intervals is an opportunity for improvement.
目的：评估加州大学洛杉矶分校健康无家可归者医疗合作组织（HHC）进行的即时护理（POC）测试的使用情况和结果，以确定无家可归者（PEH）尤其是糖尿病患者的诊断模式，为未来的护理模式提供信息。方法：对2023年1月至2024年8月期间到HHC流动单位就诊的PEH患者的电子健康记录进行回顾性队列研究。评估护理点试验的数量、时间和结果。综合代谢组（CMP）、血糖和血红蛋白A1c （HbA1c）结果在初次就诊时被评估为糖尿病和非糖尿病队列之间的差异。结果：在2023年1月至2024年8月期间，HHC服务了4653例患者，其中836例接受了POC检测（17.97%）。在此期间，126项基础代谢检测、197项cmp检测、102项COVID-19抗原检测、533项血糖检测、166项糖化血红蛋白检测、87项血红蛋白检测、80项甲型流感和乙型流感检测、22项快速甲型链球菌检测、119项尿试纸检测和41项尿妊娠检测。在所有测试中，190例（22.73%）获得了糖尿病国际疾病分类代码。在CMP结果中，糖尿病患者的平均钠（139.5 vs 141.1 mmol/L, P < 0.05）和平均氯化物（103.7 vs 105.8 mmol/L, P < 0.05）均较低。平均肌酐差异无统计学意义（0.91 vs 1.06 mg/dL; P = 0.097）。结论：即时检测为PEH，特别是糖尿病患者提供了关键的诊断数据，使临床医生能够在严重疾病发展之前开始治疗。扩大测试菜单，包括尿白蛋白与肌酐比率筛选和创建pocc特异性参考区间是一个改进的机会。
期刊介绍：
The American Journal of Clinical Pathology (AJCP) is the official journal of the American Society for Clinical Pathology and the Academy of Clinical Laboratory Physicians and Scientists. It is a leading international journal for publication of articles concerning novel anatomic pathology and laboratory medicine observations on human disease. AJCP emphasizes articles that focus on the application of evolving technologies for the diagnosis and characterization of diseases and conditions, as well as those that have a direct link toward improving patient care.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
