The Siemens DCA Systems microalbumin/creatinine assay is a quantitative test that measures low concentrations of albumin and creatinine in urine and generates an albumin-to-creatinine ratio. This test is important for early detection of kidney disease in diabetic patients. The reported range of albumin for this assay is 5 to 300 mg/L. To more accurately identify samples with albumin levels of greater than 300 mg/L on the DCA point-of-care systems, several antibody sources were screened and qualified using the Siemens ADVIA 1200 (545 nm) and the Roche COBAS MIRA (500 nm) systems. A research study was conducted on 3 full cartridge lots, and the results are described. Precision testing showed within-run coefficient of variation (%) was 5.8%, 4.7%, and 3.5%, and total coefficient of variation (%) was 6.6%, 5.2%, and 4.3% for the 3 controls tested.Using the ADVIA 1200 as the comparative method, a correlation study was performed on 40 natural human urine samples, ranging from 11 to 275 mg/L of albumin. The combined regression analysis for the 3 lots had a slope of 1.02, an R 2 of 0.98, and an intercept of 1.1 mg/L. Forty natural human urine samples ranging from 2063 to 5987 mg/L of albumin were used to demonstrate high-dose-hook mitigation with the 3 lots. Every result reported was greater than 300 mg/L. Conclusions:The data show that all lots demonstrated excellent precision and correlation with another commercial method. Samples of up to nearly 6000 mg/L of albumin were tested successfully with all 3 lots, and 100% of results were reported as greater than 300 mg/L.

Introduction: HealthPathways is a clinical information portal developed in New Zealand that enables general practitioners to manage and refer their patients in a local context. We analyzed specialist outpatient appointment costs in Mackay, Queensland before and after HealthPathways implementation. Methods: We retrospectively examined specialist outpatient costs for patients referred by Mackay general practitioners for conditions with varying levels of HealthPathways implementation. Ranked from most clinical pathways available to none, chronic diabetes, cardiology, respiratory, and urology visits from January to March 2015, pre-pathways, and January to March 2017, post-pathways, were assessed. Monte Carlo simulation was used to estimate cost changes. Per-visit costs were multiplied by visit numbers to estimate policy impact. Results: The mean cost per visit increased from $220 to $305 for diabetes and $270 to $323 for respiratory, and decreased from $296 to $257 for cardiology and $444 to $293 for urology. The policy impact for each disease group over 3 months after accounting for visit numbers was a likely saving of $30 360 for diabetes and $10 270 for cardiology, and a likely cost increase of $24 449 for respiratory and $20 536 for urology. Conclusions: We observed that conditions with more comprehensive clinical pathways cost Mackay HHS substantially less following implementation. Costs for low and no pathway implementation referrals increased slightly over the same period.