All Case Examples

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

Montefiore MedicalCenter (Montefiore) in the Bronx, New York, serves one of the poorest and most diverse urban communities in the United States. Each year, Montefiore logs 93,000 admissions and 2.6 million ambulatory visits in nearly 100 networked locations. Medicaid and Medicare accounted for 80% of patient revenue in 2011.