采用基于证据的跨学科团队方法优化个性化骨髓检测。
Optimizing personalized bone marrow testing using an evidence-based, interdisciplinary team approach.
机构信息
Depts of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Room C-3321A, 1161 21st Ave S, Nashville, TN 37232-2561;
出版信息
Am J Clin Pathol. 2013 Nov;140(5):643-50. doi: 10.1309/AJCP8CKE9NEINQFL.
OBJECTIVES
To address the overuse of testing that complicates patient care, diminishes quality, and increases costs by implementing the diagnostic management team, a multidisciplinary system for the development and deployment of diagnostic testing guidelines for hematologic malignancies.
METHODS
The team created evidence-based standard ordering protocols (SOPs) for cytogenetic and molecular testing that were applied by pathologists to bone marrow biopsy specimens on adult patients. Testing on 780 biopsy specimens performed during the six months before SOP implementation was compared with 1,806 biopsy specimens performed during the subsequent 12 months.
RESULTS
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.
CONCLUSIONS
This process is a model for optimizing complex and personalized diagnostic testing.
目的
通过实施诊断管理团队，即一个用于制定和实施血液恶性肿瘤诊断检测指南的多学科系统，解决导致患者治疗复杂化、降低医疗质量和增加成本的过度检测问题。
方法
该团队为细胞遗传学和分子检测制定了基于证据的标准医嘱协议（SOP），病理学家将这些 SOP 应用于成年患者的骨髓活检标本。在实施 SOP 之前的六个月内对 780 个活检标本进行了检测，与随后的 12 个月内对 1806 个活检标本进行的检测进行了比较。
结果
实施后，与 SOP 不符的检测、遗漏的检测以及向付款人估计的检测成本显著减少。阳性检测的比例增加。临床医生报告接受了新程序，并认为节省了时间。
结论
该流程是优化复杂和个性化诊断检测的典范。
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