Diagnostic Management Teams: Filling a Void in Value-based Care
Ensuring the right tests are carried out and diagnostic reports are easily understood by care teams
The number, sophistication and costs of diagnostic tests in medicine have exploded in the past few decades. Genomics and combined imaging modalities are among many new diagnostic tools. Even for experienced physicians, this can lead to both over- and under-utilization of tests and treatment, adding significant costs and causing delays in diagnosis. A diagnostic management team (DMT) led by pathologists and other experts in the clinical laboratory can partner with physicians to ensure the right tests are carried out and diagnostic reports are easily understood by all members of a care team.
Faced with endless complexity, many physicians, minimally trained in test selection and interpretation, order tests that result in isolated bits of diagnostic data, results that are then simply "thrown over the wall to diagnostic physicians and pathologists," said Michael Laposata, MD, PhD, FCAP, a professor and chairman of the department of pathology at the University of Texas Medical Branch-Galveston. Laposata has been speaking and writing about the need for laboratory consultations and diagnostic management teams for many years.
Traditional practice leaves the pathology team to somehow piece together the puzzle of a diagnosis from almost random test results and the patient's clinical record. Its report, which includes a diagnosis or a short list of diagnostic options, is then "thrown back over the wall" to the treating provider, Laposata said, without enough context and dialogue.
The process of creating a modern DMT is about removing that wall. "There's a tremendous advantage if you run a health care system to having your treating physicians seeing patients and your diagnostic physicians telling the treating physicians, 'Here's what we think,'" he said. "Everybody talks to one another, and we’ve united all the diagnostic information. It should be one-stop-shopping for the treating physician, who can get information about imaging, clinical laboratory and anatomic pathology, and we have a diagnostic arm and a treating arm working to the top of their licenses."