title: External Quality Assessment in Croatia: problems, challenges, and specific circumstances.
abstract: In Croatian medical laboratories (ML), external quality assessment (EQA) has a long tradition of almost half of a century. At national level, EQA is provided by Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM) which is a part of Croatian Society of Medical Biochemistry and Laboratory Medicine. This case study aimed to summarize the main challenges, which are set to CROQALM and their possible solutions. CROQALM has 10 schemes, covering majority of analysis for which medical biochemistry laboratories in Croatia are authorized for, including pre-analytical and post-analytical phase of laboratory work. Assessment scheme has three exercisesperyear. One sampleperscheme and exercise is distributed to participants depending on their application. All data transfer and evaluation of the results are done using web interface and statistical software for evaluation of quality in laboratory medicine. Since CROQALM has relatively small number of participating laboratories (N = 197) with lot of different manufacturers of instruments used for analysis in all schemes, constant challenges are present in the evaluation of the results (commutability problems, statistical analysisetc.). Further, number of participating medical laboratories is even lower for highly specific parameters, which are in the scope of clinical laboratories only. Despite the obstacles we are faced to, EQA at national level is useful tool regarding standardization and harmonization aspects in total testing process within the country. Furthermore, it gives participating laboratories recognition and proof for meeting expected quality criteria in the community they serve.
authors.affiliation: Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia.
authors.forename: Jasna Lenicek
authors.initials: JL
authors.lastname: Krleza
authors.affiliation: Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Clinical Institute of Chemistry, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Celap
authors.affiliation: Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia.
authors.forename: Jelena Vlasic
authors.initials: JV
authors.lastname: Tanaskovic
mesh_terms: D019411:Clinical Laboratory Techniques / Q000592:standards*; D017523:Croatia; D006801:Humans; D013677:Medical Laboratory Science / Q000592:standards*; D010338:Pathology, Clinical / Q000592:standards*; D011785:Quality Assurance, Health Care; D011786:Quality Control
keywords: allowable limit of performance; commutability; external quality assessment; harmonization; standardization