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Jhaveri TA, Weiss ZF, Winkler ML, Pyden AD, Basu SS, Pecora ND. A decade of clinical microbiology: top 10 advances in 10 years: what every infection preventionist and antimicrobial steward should know. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e8. [PMID: 38415089 PMCID: PMC10897726 DOI: 10.1017/ash.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024]
Abstract
The past 10 years have brought paradigm-shifting changes to clinical microbiology. This paper explores the top 10 transformative innovations across the diagnostic spectrum, including not only state of the art technologies but also preanalytic and post-analytic advances. Clinical decision support tools have reshaped testing practices, curbing unnecessary tests. Innovations like broad-range polymerase chain reaction and metagenomic sequencing, whole genome sequencing, multiplex molecular panels, rapid phenotypic susceptibility testing, and matrix-assisted laser desorption ionization time-of-flight mass spectrometry have all expanded our diagnostic armamentarium. Rapid home-based testing has made diagnostic testing more accessible than ever. Enhancements to clinician-laboratory interfaces allow for automated stewardship interventions and education. Laboratory restructuring and consolidation efforts are reshaping the field of microbiology, presenting both opportunities and challenges for the future of clinical microbiology laboratories. Here, we review key innovations of the last decade.
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Affiliation(s)
- Tulip A. Jhaveri
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Zoe Freeman Weiss
- Division of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
- Division of Geographic Medicine & Infectious Disease, Tufts Medical Center, Boston, MA, USA
| | - Marisa L. Winkler
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexander D. Pyden
- Division of Pathology and Laboratory Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Boston, MA, USA
| | - Sankha S. Basu
- Division of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA, USA
| | - Nicole D. Pecora
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
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2
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Blakey GL, McCloskey CB, Guthridge JM, Williams CL, Lu R, Hayes JT, Pinkston KG, Talbert ML. COVID-19 Pandemic Spurs Evolution of an Academic Pathology Department and Laboratory. Acad Pathol 2021; 8:23742895211037029. [PMID: 34458566 PMCID: PMC8385575 DOI: 10.1177/23742895211037029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/25/2021] [Accepted: 06/27/2021] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic has caused much suffering through disease and death, disruption of daily life, and economic havoc. Global health infrastructure has been challenged, in some cases failing. In the United States, the inability of laboratories to provide adequate testing for the causative pathogen, severe acute respiratory syndrome coronavirus 2, has been the subject of negative press and national debate. Even so, these challenges have prompted pathology practices and clinical labs to change their organizations and operations for the better. The natural positive evolution of the University of Oklahoma Department of Pathology and OU Health Laboratories has been greatly accelerated by the global pandemic. While developing a substantial COVID testing response, our department of pathology and laboratories have evolved a much nimbler organizational structure, established an important research partnership, built a translational research resource, created a significant reference lab capability, and completed many key hires against a national background of hiring freezes and pay cuts. Also, the high visibility of the clinical lab and pathologists during the outbreak has reinforced the value of lab medicine to patient care across our health system. In the midst of significant ongoing changes to the structure and financing of our underlying organizations, high trust among departmental, hospital, health system, and medical school leadership during the pandemic has promoted these positive changes, allowing us to emerge much stronger from this crisis.
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Affiliation(s)
- Gregory L Blakey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cindy B McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joel M Guthridge
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Christopher L Williams
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rufei Lu
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Michael L Talbert
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Bailey DN, Crawford JM, Jensen PE, Leonard DGB, McCarthy S, Sanfilippo F. Generating Discretionary Income in an Academic Department of Pathology. Acad Pathol 2021; 8:23742895211044811. [PMID: 34595334 PMCID: PMC8477684 DOI: 10.1177/23742895211044811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 01/09/2023] Open
Abstract
The 2021 Association of Pathology Chairs Annual Meeting included a chairs' session and a premeeting discussion-group webinar sponsored by the Senior Fellows Group (former chairs of academic departments of pathology who have remained active in the Association of Pathology Chairs) focused on generating discretionary income for departments. Discretionary income was defined as revenue that can be used by the department with few, if any, restrictions. Such income is particularly desirable given limitations on departmental budgets. Four discussion-group panelists presented the funds-flow model in their respective institutions and how they derived and used discretionary income. Discretionary income was obtained from both external sources (eg, philanthropy, indirect cost recovery, partnerships with outside entities, medical education courses, research laboratory agreements, clinical trials) and internal sources (eg, core facilities, institutional programmatic support, institutional incentive programs). Significant departmental variations were associated with differences in institutional financial structure and policies, revenue-generating capabilities of the department and individual faculty, practice plan policies, donor intentions, and geographic market forces. Most finances were dependent upon a robust funds-flow model. Uses of discretionary funds included salary support, recruitment expenses (including start-up packages), research equipment, space renovation, social events, support of academic programs, and travel. Panelists also discussed particular challenges of discretionary-fund generation and use during the coronavirus disease 2019 pandemic. Notably, each institution had its own unique methodology for generating discretionary income, and no obvious standard approach was identified. The 2 moderators emphasized the importance of identifying and understanding opportunities, issues, and institutional culture surrounding generation and use of discretionary funds.
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Affiliation(s)
- David N. Bailey
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Peter E. Jensen
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Debra G. B. Leonard
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Susan McCarthy
- Department of Pathology and Laboratory Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory, University, Atlanta, GA, USA
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Reichberg SB, Mitra PP, Haghamad A, Ramrattan G, Crawford JM, Berry GJ, Davidson KW, Drach A, Duong S, Juretschko S, Maria NI, Yang Y, Ziemba YC. Rapid Emergence of SARS-CoV-2 in the Greater New York Metropolitan Area: Geolocation, Demographics, Positivity Rates, and Hospitalization for 46 793 Persons Tested by Northwell Health. Clin Infect Dis 2020; 71:3204-3213. [PMID: 32640030 PMCID: PMC7454448 DOI: 10.1093/cid/ciaa922] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/07/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In March 2020, the greater New York metropolitan area became an epicenter for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The initial evolution of case incidence has not been well characterized. METHODS Northwell Health Laboratories tested 46 793 persons for SARS-CoV-2 from 4 March through 10 April. The primary outcome measure was a positive reverse transcription-polymerase chain reaction test for SARS-CoV-2. The secondary outcomes included patient age, sex, and race, if stated; dates the specimen was obtained and the test result; clinical practice site sources; geolocation of patient residence; and hospitalization. RESULTS From 8 March through 10 April, a total of 26 735 of 46 793 persons (57.1%) tested positive for SARS-CoV-2. Males of each race were disproportionally more affected than females above age 25, with a progressive male predominance as age increased. Of the positive persons, 7292 were hospitalized directly upon presentation; an additional 882 persons tested positive in an ambulatory setting before subsequent hospitalization, a median of 4.8 days later. Total hospitalization rate was thus 8174 persons (30.6% of positive persons). There was a broad range (>10-fold) in the cumulative number of positive cases across individual zip codes following documented first caseincidence. Test positivity was greater for persons living in zip codes with lower annual household income. CONCLUSIONS Our data reveal that SARS-CoV-2 incidence emerged rapidly and almost simultaneously across a broad demographic population in the region. These findings support the premise that SARS-CoV-2 infection was widely distributed prior to virus testing availability.
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Affiliation(s)
- Samuel B Reichberg
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
- Northwell Health Laboratories, Northwell Health, Lake Success, New York, USA
| | - Partha P Mitra
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Cold Spring Harbor Laboratory, Northwell Health, Cold Spring Harbor, New York, USA
| | - Aya Haghamad
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
- Northwell Health Laboratories, Northwell Health, Lake Success, New York, USA
| | - Girish Ramrattan
- Northwell Health Laboratories, Northwell Health, Lake Success, New York, USA
| | - James M Crawford
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
- Northwell Health Laboratories, Northwell Health, Lake Success, New York, USA
| | | | - Gregory J Berry
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
- Northwell Health Laboratories, Northwell Health, Lake Success, New York, USA
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Alex Drach
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Scott Duong
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
- Northwell Health Laboratories, Northwell Health, Lake Success, New York, USA
| | - Stefan Juretschko
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
- Northwell Health Laboratories, Northwell Health, Lake Success, New York, USA
| | - Naomi I Maria
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Yihe Yang
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Yonah C Ziemba
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
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Paczos TA. Mounting a Regional Response to the COVID-19 Pandemic: Another Reason to "Keep" Your Lab. Arch Pathol Lab Med 2020; 144:1321-1324. [PMID: 32649214 DOI: 10.5858/arpa.2020-0397-sa] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Declining reimbursement shifts hospital laboratories from system assets to cost centers. This has resulted in increased outsourcing of laboratory services, which can jeopardize a hospital systems' ability to respond to a health care crisis. OBJECTIVES.— To demonstrate that investment in a core laboratory serving an academic medical center equipped a regional health system to respond to the Coronavirus disease 2019 (COVID-19) pandemic. DESIGN.— COVID-19 diagnostic testing data were analyzed. Volumes were evaluated by result date (March 16, 2020-May 6, 2020), and the average of received-to-verified turnaround time was calculated and compared for in-house and send-out testing, and different in-house testing methodologies. RESULTS.— Daily viral diagnostic testing capacity increased by greater than 3000% (from 21 tests per day to 658 tests per day). Total viral diagnostic testing reported by the core laboratory increased by 128 times during 22 days of test method validation and 826 times during the analysis period, while average turnaround time per day for send-out testing increased from 3.7 days to 21 days. Decreased overall average turnaround time was observed at the core laboratory (0.45 days) versus send-out testing (7.63 days) (P < .001). CONCLUSIONS.— Investment in a core laboratory provided the health system with the necessary expertise and resources to mount a robust response to the pandemic. Local access to testing allowed rapid triage of patients and conservation of scarce personal protective equipment (PPE). In addition, the core laboratory was able to support regional health departments and several hospitals outside of the system.
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Affiliation(s)
- Tamera A Paczos
- From the Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
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Ducatman BS, Ducatman AM, Crawford JM, Laposata M, Sanfilippo F. The Value Proposition for Pathologists: A Population Health Approach. Acad Pathol 2020; 7:2374289519898857. [PMID: 31984223 PMCID: PMC6961144 DOI: 10.1177/2374289519898857] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 01/09/2023] Open
Abstract
The transition to a value-based payment system offers pathologists the opportunity to play an increased role in population health by improving outcomes and safety as well as reducing costs. Although laboratory testing itself accounts for a small portion of health-care spending, laboratory data have significant downstream effects in patient management as well as diagnosis. Pathologists currently are heavily engaged in precision medicine, use of laboratory and pathology test results (including autopsy data) to reduce diagnostic errors, and play leading roles in diagnostic management teams. Additionally, pathologists can use aggregate laboratory data to monitor the health of populations and improve health-care outcomes for both individual patients and populations. For the profession to thrive, pathologists will need to focus on extending their roles outside the laboratory beyond the traditional role in the analytic phase of testing. This should include leadership in ensuring correct ordering and interpretation of laboratory testing and leadership in population health programs. Pathologists in training will need to learn key concepts in informatics and data analytics, health-care economics, public health, implementation science, and health systems science. While these changes may reduce reimbursement for the traditional activities of pathologists, new opportunities arise for value creation and new compensation models. This report reviews these opportunities for pathologist leadership in utilization management, precision medicine, reducing diagnostic errors, and improving health-care outcomes.
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Affiliation(s)
- Barbara S. Ducatman
- Department of Pathology, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI,
USA
| | - Alan M. Ducatman
- Department of Occupational and Environmental Health Sciences, West Virginia
University School of Public Health, Morgantown, WV, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker
School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael Laposata
- Department of Pathology, University of Texas Medical Branch, Galveston, TX,
USA
| | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University School of
Medicine, Atlanta, GA, USA
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Allen TC. Threats Remain. Arch Pathol Lab Med 2019; 143:1440-1441. [PMID: 31765249 DOI: 10.5858/arpa.2019-0286-ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Timothy Craig Allen
- From the Department of Pathology, University of Mississippi Medical Center, Jackson
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