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alliedacademies
Archives of General Internal Medicine | Volume 2
&
April 04-05, 2018 | Miami, USA
International Conference on
Internal Medicine & Practice and Primary Care
International Meeting on
Breast Pathology & Cancer Diagnosis
Mark Priebe
Quality Star LLC, USA
Case review as an anatomic pathology quality assurance tool to reduce diagnostic
discordance in breast cancer
Objective: To review quality assurance case review programs
that focus on reducing cancer diagnostic discordance in
anatomic pathology and validating their ability to detect case
based interpretive error.
Design: Fromanextensivenumber of published studies, the rate
of major discrepancies identified for cancer patients referred to
another institution occur from 4.6% to 14.7%, depending on
type of tissue. However, published data indicates the current
intra-lab QA programs ability to detect these discrepancies is
only 0.8% to 1.7%. Implementing GAP analysis, four formal
anatomic pathology quality assurance case review programs,
both inter and intra-lab, were reviewed for their ability to
satisfy a set of selected design attributes known to help identify
interpretive error. Peer reviewed literature was researched
to support claims for each program’s percent compliance to
the attributes, strengths, drawbacks and best demonstrated
practices were identified.
Results: No program met the selected attribute listing 100%
and compliance ranged from 29% (met 2 of 7) to 86% (met 6 of
7) for each program.
Conclusion: Pathology laboratories and radiology departments
should be aware of the limitations of each QA program and
take into consideration their case and medical specialist mix
and current on-site concerns in order to select a program with
attributes that best match their QA goals. In general, programs
that are standardized, include external review by subspecialist
and are performed close to the final sign-out date may offer the
greatest amount of error discovery and potential to positively
influence patient outcomes and continuous improvement.
Although this study focused on discordance in cancer related
surgical pathology, case review can also be an effective tool
in discovery of all histology/cytology and medical imaging
diagnostic and clerical discrepancies.
Speaker Biography
Mark Priebe is a Subject Matter Expert in the utilization of whole slide digital imaging
for quality assurance of surgical pathology for cancer. He has presented on quality
in surgical pathology via podium and posters at multiple scientific meetings and was
the Co-Chair for Pathology 16 (Chicago). He received his Under-graduate degree in
Medical Technology from Marquette University, Milwaukee, and advance certification
by the ASCP in Immunohematology from the Medical College of Wisconsin. He is the
Co-developer of Quality Star quality consortium of Omaha Nebraska. Quality Star is
an external peer review quality assurance program for Surgical Pathology, approved
by the American Board of Pathology for Part II (SAM) and IV (QA) MOC, the Agency
for HealthCare Research and Quality (AHRQ) as a Patient Safety Organization (PSO),
Indiana State Medical Association certified for AMA PRA Category 1 Credits, and
Qualified Clinical Data Registry (QCDR) for Anatomic Pathology approved by CMS. The
Mission of Quality Star is to support the reduction of major diagnostic discordance in
surgical pathology by 5% (7 to 2%) impacting the lives of over 80,000 patients annually
in North America.
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