title: Optimizing personalized bone marrow testing using an evidence-based, interdisciplinary team approach.
abstract: OBJECTIVE
  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.
authors.affiliation: Depts of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Room C-3321A, 1161 21st Ave S, Nashville, TN 37232-2561; mary.zutter@vanderbilt.edu.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Seegmiller
authors.forename: Annette S
authors.initials: AS
authors.lastname: Kim
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Mosse
authors.forename: Mia A
authors.initials: MA
authors.lastname: Levy
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Thompson
authors.forename: Megan K
authors.initials: MK
authors.lastname: Kressin
authors.forename: Madan H
authors.initials: MH
authors.lastname: Jagasia
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Strickland
authors.forename: Nishitha M
authors.initials: NM
authors.lastname: Reddy
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marx
authors.forename: Kristy J
authors.initials: KJ
authors.lastname: Sinkfield
authors.forename: Herschel N
authors.initials: HN
authors.lastname: Pollard
authors.forename: W Dale
authors.initials: WD
authors.lastname: Plummer
authors.forename: William D
authors.initials: WD
authors.lastname: Dupont
authors.forename: Edward K
authors.initials: EK
authors.lastname: Shultz
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: William W
authors.initials: WW
authors.lastname: Stead
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Santoro
authors.forename: Mary M
authors.initials: MM
authors.lastname: Zutter
mesh_terms: D001853:Bone Marrow / Q000473:pathology*; D001854:Bone Marrow Cells / Q000473:pathology*; D002985:Clinical Protocols; D019317:Evidence-Based Medicine; D019337:Hematologic Neoplasms / Q000175:diagnosis*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D017410:Practice Guidelines as Topic; D057285:Precision Medicine / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results
keywords: Genetics; Hematopathology; Informatics; Molecular diagnostics