National Pathology Quality Registry

The National Pathology Quality Registry (NPQR) is a national quality and benchmarking program led by ASCP. The registry captures data that measure adherence to clinical practice guideline recommendations, quality and performance standards, and appropriate utilization of laboratory testing.

About NPQR

Information for Interested Laboratories

Measures and Reporting

Learn About NPQR

National Pathology Quality Registry

The National Pathology Quality Registry (NPQR) is a national quality and benchmarking program led by ASCP. As a tool focused on continuous quality improvement and business analytics, the registry captures data that measure adherence to clinical practice guideline recommendations, quality and performance standards, and appropriate utilization of laboratory testing.

Benefits of NPQR

NPQR helps laboratories optimize quality and performance in several key ways.

Monitoring appropriate utilization of laboratory testing.
Improving pre-analytical processes.
Optimizing turnaround time and critical value reporting.
Establishing best practices through national and peer group comparisons.
Assessing analytical and diagnostic accuracy.

Quick NPQR Program Facts

Developed as a tool for pathologists and laboratory professionals to promote best practices within laboratory medicine. This tool will also benefit our clinical colleagues and ultimately improve patient care.
Designed with laboratory information system providers, the Registry supports integration with multiple LIS and includes quality and performance measures spanning several categories.

Learn more about how NPQR protects patient privacy, ensures data security, and complies with HIPAA regulations through our privacy and security white paper.

Download White Paper

Facts About NPQR Design

Why is NPQR Needed?

The NPQR planning process revealed that among laboratories and institutions, there is a need for a guidelines-driven, national quality measurement platform.

Who Participated in the design of NPQR?

NPQR is designed with guidance from your peers. An ASCP-appointed NPQR Steering Committee, along with input from several task forces focusing on specific clinical areas, has been designing the first version of the Registry. The planning phase of NPQR included interviews with stakeholders, surveys of ASCP membership priorities, and additional research.

What Reports and other features does NPQR include?

The Registry provides participants with standard reports as well as interactive dashboards that allow laboratories to analyze their performance across tests, responsible staff, and other dimensions.

Facts About NPQR Participation

Who can participate?

Any US-based laboratory can participate in NPQR, to include
- Clinical pathology laboratories/laboratory medicine practices
- Pathology laboratories/practices
These entities can participate on an individual laboratory/practice basis, or as part of a hospital system, reference laboratory network, or other group entity.

How will the Registry benefit physicians who participate?

NPQR provides pathologists and laboratory professionals with guidelines-driven performance measurement, benchmarking, and quality improvement capabilities. It enables laboratories to identify areas for improvement, integrate results into educational programs, and measure adherence to appropriate utilization of laboratory testing.

Do I need to manually enter data, or can I use automated feeds from my existing LIS?

In order to minimize manual data entry, ASCP is working with laboratory systems vendors to integrate the Registry directly in their products. Additionally, laboratories that wish to connect their lab systems using their existing information technology capabilities are also allowed to certify for Registry submission.

Is the data my lab provides secure and/or anonymous?

Yes. NPQR is compliant with the Health Information Portability and Accountability Act of 1996 (HIPPA) and Health Information Technology for Economic and Clinical Health (HITECH) Act.

How to Participate

Interest Form

Interested laboratories should complete the NPQR Interest Form below to be included in NPQR updates.

Contact for More Information

To learn more about the National Pathology Quality Registry, please contact Ali Brown, MD, FASCP, Chief Officer, Medical Quality, ASCP, and the ASCP NPQR team at NPQR@ascp.org.

Measures and Reporting

About NPQR Measures and Reporting

The National Pathology Quality Registry is a member-driven initiative that will allow participants to collect and disseminate data critical to quality improvement in the laboratory. NPQR measures were created by pathologists and laboratory professionals to provide a trusted source for best practices and benchmarking. This interactive resource applies data aggregation and visualization tools to data from your lab’s LIS to help you develop projects to improve patient care and reduce costs.

As a tool focused on continuous quality improvement and business analytics, NPQR offers 30 NPQR-exclusive performance measures. NPQR measures were developed to apply to a wide variety of pathology specialties and practices.

NPQR Performance Measures

These measures are exclusive to NPQR and can be utilized for benchmarking and quality improvement practices in the laboratory. They are not used for CMS reporting to satisfy MIPS. Laboratories can choose to provide data on any or all of these measures, as they relate to their particular practice.

Click the measure categories below to view the related measures and their descriptions. Use the button below to download a PDF with additional details about each measure.

Download Performance Measures

Appropriate Use of Laboratory Testing

Notification to the Ordering Provider Requesting 25-OH-Vitamin D Testing
Measure Description: Percentage of ordering providers who ordered a 25-OH-Vitamin D, who were informed by the laboratory this test is not beneficial for patients who do not have suspected osteoporosis, chronic kidney disease, malabsorption or obesity

Or follow practice patterns without the need for clinician notification with:

Don’t Order Population Based Screening For 25-OH-Vitamin Deficiency
Measure Description: Percentage of patients who have a 25-OH-Vitamin D performed

Test for Troponin I or T in the Diagnosis of Acute Myocardial Infarction (AMI). Don’t Use Myoglobin or CK-MB.
Measure Description: Percentage of patients who have a diagnosis of AMI, that have a troponin I or T test performed

In the Initial Screening of a Patient with a Suspected Thyroid Disorder Perform only a Thyroid Stimulating Hormone (TSH) Test, and if Abnormal, Follow up with Additional Evaluation Depending on Findings
Measure Description: Percentage of patients who have only a Thyroid Stimulating Hormone (TSH) performed in the evaluation of non-neoplastic thyroid disease

In Cases of Suspected Acute Pancreatitis Test for Lipase. Do Not Test for Amylase.
Measure Description: Percentage of patients who have lipase testing performed when suspecting acute pancreatitis

Notification to the Provider Ordering Repeat Blood Chemistry Panels in Clinically Stable Patients Within Four Days.
Measure Description: Percentage of providers who ordered a repeat blood chemistry panel within four days on an individual patient, in greater than 10% of their patients tested, who were notified by the laboratory that repeat testing is not likely beneficial in clinically stable patients.

Notification to the Provider Ordering Repeat C. difficile Stool Toxin Testing Within Seven Days.
Measure Description: Percentage of providers who ordered repeat C. difficile stool toxin testing within seven days on an individual patient, who were notified by the laboratory that repeat testing is not beneficial, and can lead to increased false positive test results.

Notification to the Provider Ordering Repeat Complete Blood Counts (CBCs) in Clinically Stable Patients Within Four Days.
Measure Description: Percentage of providers who ordered a repeat CBC within four days on an individual patient, in greater than 10% of their patients tested, who were notified by the laboratory that repeat testing is not likely beneficial in clinically stable patients.

Notification to the Provider Ordering Repeat Hepatitis C Serology Testing on a Patient With Previously Positive Results.
Measure Description: Percentage of providers who ordered repeat Hepatitis C serology testing on a patient with previously positive results, who were notified by the laboratory that repeat testing is not beneficial.

Improving Pre-Analytical Processes

Test Not Performed or Results Canceled
Measure Description: The percentage of tests that were not performed or results not available due to any of the following reasons: inadequate container, inappropriate volume, compromised sample, sample contamination, improper storage or transport; or any combination of these reasons

Test Not Reordered after Cancellation Due to Pre-Analytical Issue or Error (Within 24 Hours Inpatient)
Measure Description: Percentage of tests that were reordered as a result of that test not being performed or results not available due to any of the following reasons: inadequate container, inappropriate volume, compromised sample, contamination, improper storage or transport; or any combination of these reasons

Test Not Reordered after Cancellation Due to Pre-Analytical Issue or Error (Within 60 days Outpatient)
Measure Description: Percentage of tests that were reordered as a result of that test not being performed or results not available due to any of the following reasons: inadequate container, inappropriate volume, compromised sample, contamination, improper storage or transport; or any combination of these reasons

Optimizing Turnaround Time and Critical Value Reporting

Time Interval: Sample Collection to Results Verified
Measure Description: Time interval of tests recorded from sample collection until results are verified (Clinical Pathology)

Time Interval: Sample Collection to Sample Received
Measure Description: Time interval of tests recorded from sample collection time until sample is received in the laboratory (Anatomic and Clinical Pathology)

Time Interval: Sample Received to Results Verified / Case Signed Out
Measure Description: Time interval of tests recorded from the time a sample is received in the laboratory until results are verified (Clinical Pathology)

Time Interval: Critical Value Reporting
Measure Description: Measurement of the time interval beginning when results are verified until the critical value is reported (Clinical Pathology)

Rate of Critical Value Reporting for Cerebrospinal Fluid - White Blood Cell (CSF-WBC)
Measure Description: The percentage of CSF-WBC tests reported by a laboratory back to the ordering provider as critical when the CSF-WBC test results in a critical value

Rate of Critical Value Reporting for Chemistry Tests
Measure Description: The percentage of chemistry tests; Sodium, Potassium, Chloride, Calcium, Bicarbonate, Ammonia, Total Bilirubin – Newborn, Arterial Blood Gases – pH, PO2, PCO2, Glucose, Glucose – Newborn, reported by a laboratory back to the ordering provider as critical when a chemistry test results in a critical value

Rate of Critical Value Reporting for Troponin
Measure Description: The percentage of troponin tests reported by a laboratory back to the ordering provider as critical when a troponin test results in a critical value

Rate of Critical Value Reporting for Toxicology
Measure Description: The percentage of carbamazepine, phenobarbital, acetaminophen toxicology tests reported by a laboratory back to the ordering provider as critical when the test results in a critical value

Assessing Diagnostic Accuracy

Total Discrepancies Overall Rate
Measure Description: Rate of major and minor discrepancies per overall cases evaluated

Major Discrepancy Rate
Measure Description: Rate of major discrepancies per overall cases evaluated

Misidentified Cases
Measure Description: Rate of cases with incorrect patient demographics and/or anatomic location

Non-Diagnostic Error Rate
Measure Description: Rate of cases in which there is missing or incorrect information or typographical inaccuracies are present

All Specimen Defects Rate
Measure Description: Rate of cases in which any specimen defect occurs

Major (Only) Specimen Defects Rate
Measure Description: Rate of cases in which a major defect in specimen processing occurs

Rate of Major Discrepancy in Diagnosis between Frozen Section and Final Diagnosis
Measure Description: Rate of major discrepancies when comparing diagnosis from a frozen section to the final diagnosis

Rate of Surgical Anatomic Pathology Case Review
Measure Description: Rate of retrospective review of all surgical pathology cases

Rate of Preliminary Autopsy Diagnosis (PAD) Sign Out
Measure Description: Rate of autopsy preliminary anatomic diagnoses (PAD) signed out in less than two business days

Rate of Review of Pap Test Samples Interpreted as Negative
Measure Description: Rate of Pap test samples interpreted as negative by the cytotechnologist that are reevaluated by a pathologist or a qualified supervisory cytotechnologist prior to reporting

Non-small Cell Lung Carcinoma (NSCLC) Ancillary Biomarker Testing Status and Turnaround Time From Point of Specimen Accession Date to Ancillary Testing Completion and Reporting Date Should Be ≤10 days
Measure Description: Percentage of lung cytopathology or pathology specimen cases with non-small cell lung carcinoma (NSCLC) that address presence or absence of actionable targets through ancillary biomarker testing AND meet the maximum 10-day turnaround time (TAT) requirement (report date of ancillary biomarker testing – accession date = ≤ 10 days).

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