title: BAM! Utilizing the frequency of Benign, Atypical and Malignant diagnoses for quality improvement in the histopathologic diagnosis of melanocytic neoplasms.
abstract: BACKGROUND
  Healthcare quality measures are metrics that quantify medical outcomes. There is a need for performance indicators in the diagnosis of melanocytic neoplasms. We sought to determine whether the atypical to malignant diagnosis ratio (AMR) and benign to malignant diagnosis ratio (BMR) could identify differences between practitioners within a group as well as individual diagnostic drift.
  
  
  METHODS
  Diagnoses of melanocytic neoplasms from 2013 and 2014 by two dermatopathologists were prospectively subclassified as benign, atypical or malignant and reported on a monthly basis to the pathologists. Case diagnoses of melanocytic neoplasms from 2012 and 2009 were retrospectively subclassified as benign, atypical or malignant for comparison.
  
  
  RESULTS
  A total of 33,169 cases were used in this study. Interpathologist AMR and BMR were significantly different. One pathologist demonstrated a significant increase in AMR over time.
  
  
  CONCLUSIONS
  AMR and BMR metrics are potential performance indicators that can measure pathologist uncertainty, identify diagnostic drift and provide a surrogate measure of the relative risk level of laboratory patient populations. If applied to multiple laboratories, AMR and BMR metrics could help inform physicians' choice of dermatopathology laboratory and provide a method for comparative analysis between laboratories.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Bush
authors.affiliation: MAWD Pathology Group, North Kansas City, MO, USA.
authors.forename: Edgar L
authors.initials: EL
authors.lastname: Hunt
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
authors.forename: Garth R
authors.initials: GR
authors.lastname: Fraga
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology*; D009508:Nevus, Pigmented / Q000175:diagnosis / Q000473:pathology*; D015588:Observer Variation; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology*; D035501:Uncertainty
keywords: diagnostic uncertainty; healthcare quality measures; melanocytic neoplasia; performance indicators; quality improvement