All Case Examples

 

Identification and treatment of vitamin D deficiency is important for musculoskeletal and extra-skeletal health. For serum vitamin D testing of at-risk populations, there are well-defined clinical indications, including osteoporosis, malabsorption, fracture, limited effective sun exposure, obesity, and institutionalized individuals, among others. In these individuals it is appropriate to measure vitamin D to determine the dose of oral vitamin D supplementation to reach target levels. Repeat testing to ensure replenishment is also warranted.

Because standards and practices—second nature to pathologists—are so readily scaled up and transferred to other domains, pathologists are well prepared to take on broad, interdisciplinary roles. The career path of Stephanie Mayfield Gibson, MD, FCAP, into population health illustrates how pathologists’ roles are evolving and are poised to accelerate.

Using metrics to pivot for change, Amanda E. Haynes, DO, FCAP, collaborated with her team to motivate a system-wide effort that saved more than $1 million in blood acquisition costs across Pennsylvania’s Geisinger Health System.

Finding ways to monitor and manage the constant stream of information that may or may not be actionable to clinicians is a prime focus for Cordelia E. Sever, MD, FCAP, and her team at Pathology Associates of Albuquerque. They are coming to grips with the need for more refined, targeted, and dynamic information management that benefits interspecialty collaboration—and the patient.

Ebola Virus Disease put the biocontainment facility at Emory University Hospital to the test and put an emphasis on team integration and safety procedures.

The Outpatient Cytopathology Center in Johnson City, Tennessee, grew into a thriving business, attributed in large part to its concentrated focus on pathologist-led services that integrate clinical care and prompt reporting of test results. CAP member Susan D. Rollins, MD, FCAP, and her two partners deliver a distinct value to patients and referring physicians alike in which FNA and surgical biopsies are among the services they perform and interpret.

As a systems-oriented physician, Alexis Byrne Carter, MD, FCAP, uses her pathologist’s curiosity and clinician’s interest in how people think as she observes, evaluates, and negotiates on behalf of patients to remove ambiguity in systems and processes.

Type 2 diabetes mellitus (T2DM) is a dangerous disease out of control: US Centers for Disease Control and Prevention (CDC) data for 2007–2010 showed that 47.5% of adults with diabetes had average blood glucose (HbA1c) levels exceeding the American Diabetes Association (ADA) target of 7.0%. The ADA estimates that T2DM accounts for $1 of every $5 spent on health care in the United States, and the CDC puts diabetes prevalence at 8% of the US population. A December 2014 ADA report pointed to a 74% increase in the cost of prediabetes and an 82% increase in the cost of undiagnosed diabetes between 2007 and 2012.

When Liron Pantanowitz, MD, FCAP, is thinking about launching a project, he asks himself three questions: (1) Is it the right thing to do? (2) Is it feasible? (3) Do others share his vision? If all three are a yes, it's a go.

The most persuasive arguments for the value of pathology will be direct, concrete, and evidence based.

Many physicians worry about whether patients with chronic pain take their medication incorrectly or in combination with other substances, but few have the toxicology expertise required to know for sure. Physicians on staff at Tufts Medical Center are fortunate in this regard. Hospital guidelines to address ambulatory management of patients with chronic pain include instructions for follow-up that feature a number to call for further advice. That number connects them to the telephone of Barbarajean Magnani, PhD, MD, FCAP, chair and pathologist-in-chief in Tuft's Department of Pathology and Laboratory Medicine. Dr. Magnani gets a lot of calls.

The Test Utilization Committee of the Cleveland Clinic is a multidisciplinary task force of clinicians, pathologists, administrators, and other caregivers who innovate to ensure that test utilization supports best practices and boosts patient satisfaction. Their initiatives have met those objectives while enabling cost savings or cost avoidance of $1.9 million since the first projects went live in January 2011.

Pathologists and other laboratory professionals engineer systems-oriented solutions that benefit large populations. Many positive process changes involve small steps that draw little attention. Screening all new admissions for Methicillin-resistant Staphylococcus aureus (MRSA), for example, may have sounded like a bother until clinical experience demonstrated the time and money saved downstream in hospital operations.

Whether she plans to reframe a clinical colleague's thinking about blood product utilization or enable a legislator to see that high-quality laboratory services are fundamental to population health, Kathryn T. Knight, MD, FCAP, knows that successful persuasion is nearly as much about the messaging as the message.

Practice guidelines are translational research writ large: tools that gain value as they enable evidence-based care. When more patients get better quicker because standardized procedures produce more precise and useful test results, everybody wins.

In 2008, the University of Rochester Medical Center (URMC) Perioperative Safety Committee was having concerns about specimen label accuracy. David G. Hicks, MD, FCAP, a member of the committee and director of surgical pathology, volunteered to investigate.

James M. Crawford, MD, PhD, FCAP, came to North Shore-LIJ (NSLIJ) Health System in New York in 2009, when coordinated care was just picking up steam. He joined a forward-looking health system intent upon building a model-integrated health care network in a service area of 7 million patients.

David O. Scamurra,MD, FCAP, is president of Eastern Great Lakes Pathology, a 14-member clinical and anatomic pathology group in western New York. The pathologists of Eastern Great Lakes are also members of Catholic Medical Partners (CMP), an integrated delivery system made up of Catholic Health, which has four hospitals in the Buffalo, New York, region and 950 independent physicians who care for patients served by those hospitals.

Newton-Wellesley Hospital, a 300-bed community hospital, is part of Partners HealthCare, a Boston-area integrated health system with Massachusetts General Hospital and Brigham and Women's Hospital as its anchors. In December 2011, the Centers for Medicare & Medicaid Services (CMS) Innovation Center selected Partners HealthCare to participate in the new Pioneer Accountable Care Organization (ACO) Model, accelerating its transition to more fully coordinated care.

Pathologists are creating three complementary approaches to complex clinical laboratory testing—multidisciplinary diagnostic teams, standardized order protocols, and synthetic test reports. Each has been shown to improve the quality of care and patient experience while educating clinicians and reducing the over-and underutilization of laboratory tests.