Optimizing Personalized Bone Marrow Testing Using an Evidence-Based, Interdisciplinary Team Approach

Abstract

Personalized medicine requires physicians to employ complex and expensive diagnostic analyses. However, without evidence-based standards, there is over-utilization of testing that complicates patient care, diminishes quality, and increases costs. To address this, we implemented the diagnostic management team (DMT), a multi-disciplinary system for development and deployment of diagnostic testing guidelines for hematologic malignancies. The team created evidence-based standard ordering protocols (SOPs) for cytogenetic and molecular testing that were applied by pathologists to bone marrow biopsies on adult patients. Testing on 780 biopsies performed during the 6 months before SOP implementation was compared with 1,806 biopsies performed during the subsequent 12 months. After implementation, there were significant decreases in tests discordant with SOPs, omitted tests, and the estimated cost of testing to payers. The fraction of positive tests increased. Clinicians reported acceptance of the new procedures and perceived time savings. This process is a model for optimizing complex and personalized diagnostic testing.

The new diagnostic team

“…Evidence from hematopathology has shown that the DMT optimizes complex diagnostic testing and leads to reduced test utilization, the ordering of more appropriate test, and to decreased costs [36].…”

A Limited Plasma Cell Flow Cytometry Panel With Reflex CD138 Immunohistochemistry Is an Optimal Workflow Process for Evaluating Plasma Cell Neoplasms in Bone Marrow Specimens

“…These findings are in line with a recent study that shows that using evidence-based standard ordering protocols in an interdisciplinary team approach for cytogenetic and molecular studies applied by pathologists on BM specimens resulted in significant decreases in discordant tests, omitted tests, and costs, with an increase in the fraction of positive tests. 2 Our study takes this approach one step further and demonstrates an example of a specific standardized ordering protocol to optimize PCN diagnosis and monitoring in BM samples.…”

“…These initiatives underscore the need for standardized testing algorithms and decision support mechanisms to assist physicians and pathologists in test selection in various areas of the clinical laboratory. 2 Standardized testing algorithms would reduce inefficiency and control reported overuse of clinical laboratory testing. [3][4][5][6] In particular, the inefficient or inappropriate use of ancillary testing in the diagnostic workup of bone marrow (BM) specimens has been an area of recent interest.…”

“…[3][4][5][6] In particular, the inefficient or inappropriate use of ancillary testing in the diagnostic workup of bone marrow (BM) specimens has been an area of recent interest. 2,7 This inefficiency is largely due to the lack of data on optimal workflow processes and standardization between laboratories.…”

Improving Cancer Diagnosis and Care: Patient Access to High-Quality Oncologic Pathology

“…The development of more sophisticated approaches to diagnostic testing and the growth in precision therapies are transforming cancer diagnosis and care . In the traditional paradigm of pathology testing, a clinician orders diagnostic testing, a clinical laboratory/pathologist performs the ordered tests and returns results, and an individual clinician collates and interprets the information . Now, however, there is an increasingly large, complex, and rapidly expanding menu of diagnostic testing options for clinicians to consider, with few evidence‐based guidelines and limited clinical decision support (CDS) to help with test selection and interpretation.…”