Value of biopsy in a cohort of children with high-titer celiac serologies: observation of dynamic policy differences between Europe and North America.

Background: Healthcare systems implement change at different rates because of differences in incentives, organizational processes, key influencers, and management styles. A comparable set of forces may play out at the national and international levels as demonstrated in significant differences in the diagnostic management of pediatric Celiac Disease (CD) between European and North American practitioners.

Methods: We use retrospective clinical cohorts of 27,868 serum tissue transglutaminase (tTG) immunoglobulin A levels and 7907 upper gastrointestinal endoscopy pathology reports to create a dataset of 793 pathology reports with matching tTG results between July 1 of 2014 and July 1 of 2018.

Modeling Pathology Workload and Complexity to Manage Risks and Improve Patient Quality and Safety.

Anatomic pathology (AP) laboratories provide critical diagnostic information that help determine patient treatments and outcomes, but the risks of AP operations and their impact on patient safety and quality of care remain poorly recognized and undermanaged. Hospital-based laboratories face an operational and risk management challenge because clinical work of unknown quantity and complexity arrives with little advance notice, which results in fluctuations in workload that can push operations beyond planned capacity, leading to diagnostic delays and potential errors. Modeling the dynamics of workload and complexity in AP offers the opportunity to better use available information to manage risks.