Choosing Wisely Champions Drive Healthcare Change
The American Society for Clinical Pathology (ASCP) is recognizing several healthcare leaders for their commitment to the ABIM Foundation’s Choosing Wisely campaign. The Choosing Wisely Champions program, launched by the ABIM Foundation in 2016, was created to recognize clinicians who are leading efforts to reduce overuse and waste in medicine. The program acknowledges the work of those who are dedicated to providing appropriate care and encourages others to follow their lead.
“Identifying Champions and sharing their successes allows all of us to learn from their efforts to improve healthcare delivery,” said Lee H. Hilborne, MD, MPH, DLM(ASCP)CM, FASCP, chair of the ASCP Effective Test Utilization Steering Committee.
The Choosing Wisely Champions were chosen for advancing appropriate test utilization in their health systems and demonstrating leadership of a local Choosing Wisely effort. Below are the honorees and a synopsis of their achievements.
Ila Singh, MD, PhD – Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
Dr. Singh is the chief of laboratory medicine in the Department of Pathology at Texas Children’s Hospital and a professor of pathology and immunology at Baylor College of Medicine. Dr. Singh is board-certified in clinical pathology and clinical informatics. She has expertise in laboratory test utilization management, as evidenced by her involvement in creating the Clinical and Laboratory Standards Institute (CLSI) document on test utilization, and her membership on the national committee on Lab Test Utilization and Stewardship that co-authored the consensus document on the subject. Her research is focused on using artificial intelligence/deep learning approaches to determine risk stratification, prescriptive analytics, better utilization of healthcare resources, personalized therapeutics and optimization of treatment protocols.
Curtis A. Hanson, MD – Mayo Clinic, Rochester, MN
Dr. Hanson is a professor of laboratory medicine and pathology at the Mayo Clinic and chief Medical officer for Mayo Medical Laboratories. He has been a proponent of optimal test utilization throughout his 31-year career as a pathologist and has led Mayo Clinic efforts in appropriate laboratory utilization for two decades. Most recently, he served as the physician leader for value-based testing for Mayo Medical Laboratory clients and has worked tirelessly to incorporate the tenets of the Choosing Wisely initiative into the clinical practice at the Mayo Clinic. In addition to extensive educational efforts and creation of testing algorithms for optimizing test utilization and interpretation in the fields of hematology and hematopathology early in his career, Dr. Hanson led the effort to expand this beyond his specialty area and helped lead the incorporation of laboratory utilization rules into the inpatient hospital practice at the Mayo Clinic. He led the development of the laboratory utilization rules that are used within the clinical decision support tool used at the Mayo Clinic (CareSelect). Dr. Hanson is the creator/co-creator of 25 clinician/pathologist-driven testing algorithms in hematopathology.
Diane George, DO – Henry Ford Medical Group, Detroit, MI
As the chief medical officer for primary care with the Henry Ford Medical Group, Dr. George has demonstrated extraordinary physician leadership in ensuring appropriate utilization of Vitamin D testing across the Henry Ford health system. Her group established a baseline of ordering volume and developed analytics tool to monitor total volume, as well as highlight low and high utilizers. Dr. George spoke with leaders and providers at all levels and was a public and visible champion for Choosing Wisely. Due to these efforts, the number of Vitamin D orders (from ambulatory providers distributed over 20+ sites) was reduced from 685 per month to 150 per month within the first year of implementation, and continues to decrease at an annual rate of 23 percent. Dr. George’s leadership and guidance toward appropriate Vitamin D utilization has made a significant impact in implementing ASCP’s Choosing Wiselyguidelines in Southeastern Michigan.
James Littlejohn, MD, PhD – Weill Cornell Medical Center, New York
Dr. Littlejohn is an assistant professor of clinical anesthesiology and critical care medicine at Weill Cornell Medical Center. He has worked with the Quality and Safety department’s blood utilization group, the Transfusing Wisely committee, at the University of California-Davis Medical Center, for approximately nine months to evaluate data pulled from their operating room’s electronic medical record into their transfusion registry. Dr. Littlejohn worked with the team to produce an intuitive user interface for the first version of the perioperative transfusion dashboard, strategize the best approach to begin a perioperative blood management campaign at their institution, and produce and administer a survey on perioperative red blood cell transfusions to his department. The survey data produced by Dr. Littlejohn showed that majority of anesthesiology providers consider hemoglobin </= 7 g/dL as an appropriate prophylactic red blood cell transfusion trigger in asymptomatic, otherwise healthy patients and support providing one red blood cell unit at a time for transfusion support.
Heather Signorelli, DO – HCA-HealthOne, Denver, CO
Dr. Signorelli is board certified in anatomic pathology, clinical pathology and chemical pathology and currently serves as the chief laboratory officer for HCA-HealthOne, overseeing nine hospital laboratory operations. This has included building laboratory stewardship programs for two hospital markets with an annual savings of over $2 million, and leading consolidation and standardization efforts. As of June 2018, 14 other divisions within the HCA system have built and started laboratory stewardship programs under Dr. Heather Signorelli’s leadership. The committees will initially focus on the Choosing Wisely list of obsolete tests and continue to build the program from there. The focus is on developing an infrastructure to provide a laboratory stewardship template for other divisions, gathering data and planning for resources needed to implement.
Jennifer Stumph, MD – Michigan Pathology Specialists, Grand Rapids, MI
Dr. Stumph is a pathologist at Michigan Pathology Specialists, P.C., Spectrum Health Hospitals in Grand Rapids, MI. She has worked with a group of interdisciplinary specialist standardizing breast cancer treatment protocols to provide evidence- based medicine in an efficient manner. Her study, “Sentinel Lymph Node Biopsy for Patients with DCIS: Just In Case vs. Choosing Wisely,” focuses on the added cost without added clinical value to performing sentinel lymph node biopsy on patients with DCIS. Her research is a testimony to her dedication to implementing change in a healthcare system with room for improvement. To her students, she has been a role model, demonstrating strong interpersonal skills and a passion for driving change in the healthcare field.
Pallavi Patil, MBBS, MD – Brown University and Lifespan Academic Medical Center
Dr. Patil is a fourth-year pathology resident at Brown University, Providence, RI. During her second year in residency, she started working with principal investigator Kimberle Chapin, MD, director of microbiology, to look into the PCR send-out testing for blood parasites Babesia (Bb), Plasmodium (Pm), Ehrlichia (Er), and Anaplasma (Ap) through the laboratory that entails a large non-reimbursed expenditure for the hospital lab. After looking at the results from send-out PCR tests and peripheral blood smear for parasites and serology, her team worked with hematopathology director Diana Treaba, MD, FASCP, to validate the suggested flow chart on workup for blood parasite testing. According to her study, PCR testing does not add value and should not be ordered for determination of blood parasites without initial peripheral blood smear evaluation, or consultation with pathologist. Dr. Patil is also an honoree of ASCP’s 40 Under Forty program for 2018.