The impact of timely respiratory diagnosis in decentralized care settings
As hospitals and health systems across the nation gear up for another potentially unpredictable respiratory season, the importance of timely and accurate diagnosis of respiratory illness once again takes center stage. Rapid, precise diagnostic testing plays a critical role in optimizing patient outcomes, reducing unnecessary antimicrobial utilization, and safeguarding health system resources. Realizing these benefits means understanding that the increasing decentralization of health care delivery post-pandemic requires a dynamic, strategic approach to diagnostic testing deployment.
According to a 2018 study of care delivery in emergency departments (EDs), upper respiratory infections were the second-leading cause of treat-and-release visits in the ED.1 Today, much of this volume has shifted to urgent care centers, retail clinics and outpatient testing centers—healthcare delivery destinations that rose in prominence in the wake of COVID-19. In fact, from 2019 to 2020, U.S. urgent care centers experienced a 60% increase in patient visits per center.2 In 2022 alone, these centers managed 206 million non-emergent visits.2 Further illustrating the shift in care, the number of freestanding urgent care centers has increased from 7,220 in 2014 to 14,382 in 2023,2 with more than 78% of the U.S. population now living within a 10-minute drive of an urgent care facility.2
Whether in response to the unprecedented conditions presented by COVID-19 or to address the continuing nationwide shortage of primary care physicians, urgent care centers have become a durable fixture in healthcare access and delivery. There is no denying the value of convenient, accessible care, especially when it comes to the timely diagnosis and treatment of infectious diseases that typically present with overlapping symptoms. In 2023, respiratory-related conditions accounted for nearly 25% of the ICD-10 codes used in urgent care,3 and overall since 2020, more than half of all patients seen daily in urgent care centers present with respiratory and ear-related symptoms.2 With the surge in use of urgent care to treat respiratory conditions, coupling accessibility with on-site solutions that promote timely diagnosis is key in guiding care, avoiding inappropriate treatment and reducing unnecessary ED visits.
Diagnostic delay: Understanding the costs and risks
Last year’s respiratory season hit the nation harder than anticipated, with the highest rates of hospitalizations and outpatient visits for respiratory illnesses in 15 years.4 In fact, the 2024-25 influenza season was the first classified as high severity in more than seven years.4 Adding to the clinical complexity, in October 2024, the Centers for Disease Control and Prevention (CDC) reported increased cases of Mycoplasma pneumoniae infections in the U.S., particularly in children.5 Additionally, there continues to be a rising incidence in whooping cough caused by Bordetella pertussis, with at least 10 reported deaths in 2024.6 Also last year, the CDC and other public health agencies launched enhanced monitoring of novel influenza A infections after H5N1 avian flu outbreaks in poultry and dairy cattle with associated infections in humans.
Why the retrospective? To demonstrate how unpredictable seasonality, the re-emergence of bacterial pathogens and concerns of novel virus threats—combined with year-to-year variability in disease severity—create the perfect storm for delayed diagnosis. Such delays not only contribute to poor patient outcomes, but also result in significant burdens on health systems. With the continuing shift to decentralized care settings, deployment of diagnostic resources and testing are essential to ensure an appropriate, full-scale response to addressing the unpredictable emergence of common and new pathogens.
The clinical risks associated with delayed diagnosis prevent patients from getting the care they need when they need it. Without timely and accurate identification of pathogens, patients may miss the clinical benefits of antiviral treatment. Antiviral medications are available for SARS-CoV-2 and influenza, but there is a narrow window in which these antivirals can be dispensed and still be effective. For influenza, antivirals should be administered within 48 hours of symptom onset,7 and for SARS-CoV-2, the recommendation is for antivirals to be given 5 to 7 days after symptoms start.8 Having clear and timely diagnostic information also influences antibiotic prescribing practices for upper respiratory infections. Without it, antibiotics are often prescribed empirically based on clinical presentation and without confirmation of a bacterial infection. A 2022 study on antibiotic practices revealed inappropriate prescribing in more than 42% of patients with upper respiratory symptoms in primary care settings.9 Across the board, improper antibiotic practices contribute to antibiotic resistance—widely acknowledged by both the CDC and the World Health Organization as the world’s most urgent public health threat.10,11
For health systems, the economic costs of delayed or inaccurate diagnosis of respiratory illness can be substantial. They include costs associated with return visits, downstream hospitalizations and inefficient resource utilization. Delayed diagnosis also can lead to numerous public health risks, especially considering the re-emergence and escalation of pathogens not commonly seen. For example, in the management of both pertussis and group A streptococcal pharyngitis, prompt recognition and diagnosis are critical to treatment and to reduce the likelihood of transmission to others. A multicenter randomized controlled trial on point-of-care syndromic assessment points to the effect that identification of a specific pathogen may have on people’s perception of the need for isolation.12 Timely diagnosis of respiratory illness in a decentralized care setting also provides early warning of potential community outbreaks, which can enable clinicians and healthcare systems to play a more proactive role in prevention.
The role of molecular diagnostics in decentralized settings
In decentralized care settings, molecular point-of-care testing (mPOCT) brings lab-quality polymerase chain reaction (PCR) closer to the patient, with turnaround times as fast as 15 minutes. This is significant when compared to reference lab send-outs that may take days for result reporting. The high sensitivity of PCR testing allows for reliable detection early in disease progression, giving clinicians the actionable results and confidence to test and appropriately treat patients in the same visit. In addition, syndromic testing, which detects multiple pathogens from a single sample, is advantageous for its ability to differentiate co-circulating pathogens that cause the same symptoms. This is particularly helpful during peak seasons when overlapping symptoms of illnesses such as influenza, SARS-CoV-2 and RSV make empirical diagnosis insensitive.
Hospitals and healthcare organizations with urgent care centers and other decentralized care options can leverage rapid molecular diagnostics to drive efficient care delivery, support antimicrobial stewardship initiatives, reduce avoidable ED admissions, and align with value-based care priorities. Consider these outcomes observed in decentralized care settings:
- Decreased time to results – When compared to laboratory-based PCR tests, mPOCT tests offer a significantly shorter turnaround time13,14 for results that allows for informed treatment decisions to be made in the same patient visit.
- Enhanced antimicrobial stewardship – Rapid diagnostics distinguish between bacterial and viral infections and inform appropriate treatment. One study found that results from an mPOCT for influenza in the ED contributed to appropriate changes in antimicrobial treatment plans in 61% of patients with a positive test result.15 Similar results were also observed for mPOCT in a community pharmacy; when molecular tests were used to diagnose influenza and group A strep, no inappropriate antibiotic prescribing was observed.16
- Decreased healthcare costs – Studies evaluating the impact of mPOCT implementation in the ED have identified sources of institutional cost savings including: decreases in hospital admissions, decreases in hospital length of stay, increases in bed availability following patient cohorting, and decreases in auxiliary testing.15,17,18,19
- Improved surveillance and infection control – mPOCT can also be leveraged to improve local pathogen surveillance and facilitate faster identification of local outbreaks. One study found that implementation of mPOCT for upper respiratory tract infections in congregate care facilities significantly decreased the time to outbreak identification, allowing for an earlier response for infection control.20 Another demonstrated that results from an mPOC respiratory assay positively impacted informed patient isolation strategies.12
Deploying mPOCT in decentralized settings: How to begin
As urgent care centers continue to fill an important role in healthcare delivery amid an increasingly complex clinical environment, the strategic deployment of diagnostic resources, including mPOCT, becomes imperative. To that end, providing efficient, cost-effective and patient-centered diagnostic testing requires some key considerations and action steps.
Assess current diagnostic gaps across patient touchpoints. From urgent care and outpatient centers to inpatient units and the ED, gather insights from clinicians about unmet needs and the perceived opportunities to improve diagnostic capabilities and clinical decision-making. At the community level, assess local disease prevalence and resulting burden, and evaluate current patient trends.
Invest in infrastructure to support efficient, real-time testing needs. Prepare for today and the future by evaluating technologies with expanding test menus to meet evolving patient needs. Align with operations and quality managers to evaluate how to efficiently incorporate new technologies into current workflows. Work to align with payers to maximize reimbursement strategies for testing of specific patient populations.
Embed diagnostics into care pathways and stewardship initiatives. Noting the importance of diagnostic pathways that promote diagnostic stewardship, establish governance around test utilization criteria. Define specific testing triggers and result-dependent clinical actions (e.g., isolate, treat, refer) and use diagnostics as the gatekeeper to downstream interventions (e.g., antiviral and antibiotic therapy, imaging).
Get everyone on board. The strategic deployment of diagnostics requires team buy-in. Collaborate with team leads to design role-specific training modules for clinicians, nurses, laboratory staff and administrative personnel. Educate clinicians on appropriate test use (indications, specimen collection) and result interpretation. Provide job aids, quick reference guides and easy access to technical support early and throughout implementation. Address resistance to new workflows by highlighting the clinical, operational and financial implications of mPOCT. Identify clinical champions for ongoing peer-to-peer training and incorporate feedback loops to refine and improve workflows.
Track Key Performance Indicators (KPIs) from Day 1. In addition to evaluating clinical effectiveness, provide an overview of KPIs for evaluating the operational and economic impact of mPOCT and evaluate them frequently. These may include:
- Clinical effectiveness and quality
- Time to diagnosis
- Treatment accuracy rate
- Antibiotic prescribing rate
- Antiviral appropriateness rate
- Operational efficiency
- Average visit length
- Cost avoidance per patient (avoided antibiotics, avoided ED visits)
- Test utilization rate
- Test reimbursement rate
- Patient experience and satisfaction
- Net promoter score
- Patient-reported confidence
- Patient retention rate
As care continues to shift closer to the patient, strategically deployed diagnostics must follow. For health systems, implementing molecular testing in decentralized settings is a strategic enabler of better, faster and more cost-effective care. In preparing patient care resources for the upcoming respiratory season, timely diagnoses—where and when they are needed—can help prevent minor illnesses from becoming major system burdens.
References
1 Agency for Healthcare Research and Quality Healthcare Cost & Utilization Project. Most Frequent Reasons for Emergency Department Visits, 2018, Statistical Brief #286. hcup-us.ahrq.gov. December 2021. Accessed July 31, 2025. https://hcup-us.ahrq.gov/reports/statbriefs/sb286-ED-Frequent-Conditions-2018.jsp
2 Urgent Care Association. Urgent care industry white paper: The essential nature of urgent care in the healthcare ecosystem post-COVID-19. August 2023.
3 The Journal of Urgent Care Medicine. Categorization of codes most frequently used in urgent care. jucm.com. May 30, 2024. Accessed July 31, 2025. https://www.jucm.com/categorization-of-codes-most-frequently-used-in-urgent-care/
4 Fournier T. Under the weather: Unpacking the impact of the 2024-2025 Influenza Season. Pharmacy Times. July 21, 2025. Accessed July 31, 2025. https://www.pharmacytimes.com/view/under-the-weather-unpacking-the-impact-of-the-2024-2025-influenza-season
5 Same R, Gerber J. Walking (pneumonia) down memory lane: Mycoplasma pneumoniae returns. Journal of the Pediatric Infectious Diseases Society. February 6, 2025;14(2):piaf006. doi: 10.1093/jpids/piaf006. https://pubmed.ncbi.nlm.nih.gov/39868571/
6 Hanna S, Samies N. Clinical progress note: Pertussis. Journal of Hospital Medicine. August 2025;20(8):862-865. doi: 10.1002/jhm.70080. https://pubmed.ncbi.nlm.nih.gov/40387798/
7 Centers for Disease Control and Prevention. Treatment of Flu. cdc.gov. September 9, 2024. Accessed August 4, 2025. https://www.cdc.gov/flu/treatment/index.html
8 Centers for Disease Control and Prevention. Types of COVID-19 Treatment. cdc.gov. May 8, 2025. Accessed August 4, 2025. https://www.cdc.gov/covid/treatment/index.html
9 Deb L, McGrath B, Schlosser L, et al. Antibiotic prescribing practices for upper respiratory tract infections among primary care providers: A descriptive study. Open Forum Infectious Diseases. June 17, 2022;9(7):ofac302. doi: 10.1093/ofid/ofac302. https://pubmed.ncbi.nlm.nih.gov/35891692/
10 Centers for Disease Control and Prevention. About antimicrobial resistance. cdc.gov. January 31, 2025. Accessed July 31, 2025. https://www.cdc.gov/antimicrobial-resistance/about/index.html
11 World Health Organization. Antimicrobial resistance. who.int. November 21, 2023. Accessed July 31, 2025. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
12 Meltzer A, Loganathan A, Moran S, et al. A multicenter randomized control trial: Point-of-care syndromic assessment versus standard testing in urgent care center patients with acute respiratory illness. JACEP Open. October 2024;5:e13306. doi: 10.1002/emp2.13306. https://www.jacepopen.com/article/S2688-1152(24)01465-6/fulltext
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16 Klepser D, Klepser M, Murray J, et al. Evaluation of a community pharmacy-based influenza and group A streptococcal pharyngitis disease management program using polymerase chain reaction point-of-care testing. Journal of the American Pharmacists Association. November-December 2019;59(6):872-879. doi: 10.1016/j.japh.2019.07.011. https://pubmed.ncbi.nlm.nih.gov/31474527/
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20 Tan C, Chan C, Ofner M, et al. Implementation of point-of-care molecular testing for respiratory viruses in congregate living settings. Infection Control & Hospital Epidemiology. April 25, 2024;45(9):1085-1089. doi: 10.1017/ice.2024.72. https://pmc.ncbi.nlm.nih.gov/articles/PMC11518670/
About the Author
Alesia McKeown, PhD, is a scientific partner for infectious disease in medical and scientific affairs at Roche Diagnostics.
