NEW YORK — With its sights on improving diagnostics in local healthcare, the Society to Improve Diagnosis in Medicine is into its third year of funding small-scale improvement projects that could improve access to testing and the speed of results.
Some of the 19 projects funded by this year's $50,000 grants could help catch early childhood hepatitis C infections, improve follow-up on colon cancer screenings, and improve sexually transmitted disease infection testing in urgent care facilities. The $3 million program, launched in 2020, has awarded grants to 52 projects and is on the last year of its planned three-year run.
Gerard Castro, director of quality improvement for SIDM and administrator of the DxQI Seed Grant Program, said each seed grant lets local health providers test small interventions that could improve the quality, accuracy, and timeliness of diagnosis. The organization is currently steering that money toward interventions to improve the diagnosis of cardiovascular disease, infectious disease, or cancer as well as interventions that combat disparities in healthcare or otherwise address special needs such as care for older patients.
The University of Pittsburgh Medical Center Children's Hospital, for example, said it will use its $50,000 grant to trial earlier hepatitis C testing among children who had prenatal exposure to the virus. A hepatitis C-infected mother has about a 6 percent chance of transmitting the infection to her child during pregnancy, according to the US Centers for Disease Control and Prevention.
Anne-Marie Rick, director of newborn research support services at the university's Clinical and Translational Science Institute and instructor of pediatrics and clinical and translational science at the School of Medicine, said the hospital historically conducted antigen assays for at-risk children at 18 months, the earliest point available for antibody-based screening. But the health system often loses track of many of those children through changes in address, adoptions, and changes in primary doctors, and only about 30 percent of those children exposed to the virus returned for the screenings.
"There's frequently missed opportunities to identify these children and potentially get them into care," she said.
PCR testing can identify infections in children as young as two months old, and the children's hospital plans to work with local healthcare partners to implement a testing protocol of administering those assays at two to six months, when children already have frequent wellness and primary care visits. If data from the program show improvements, the changes could roll out more broadly across local healthcare systems.
But Rick said that change still may not be possible for clinics that lack phlebotomists because those PCR tests typically require at least one milliliter of blood.
"If earlier screening is going to be the way forward to capturing these kids, we really need diagnostics tools that are targeted at this age group," she said.
Castro said some of the grant recipients who launched projects in the seed grant program's first year, 2020, are now working with SIDM as part of a community of ongoing quality improvement in medical diagnosis. The organization also has been convening grant recipients through calls and summits to share their findings.
"It's a really great opportunity for these organizations — not only to the project within their organization but also [to] share and learn at a national level," he said.
Among the successes, Castro cited as an example a 2020 project by Atrium Health Levine Children's Rheumatology Clinic to ensure the children seen at safety net clinics have access to disease monitoring and specialist care. He said the project developers created a process to provide pediatricians and general practitioners with information on those patients' conditions, the signs to monitor, and how to make referrals to rheumatological specialists.
As for this year's recipients, the project leaders see potential for the small projects to have far-reaching effects.
Scott Larson, assistant professor of gastroenterology and hepatology for the Baylor College of Medicine Houston and its affiliated program at the Michael E. DeBakey Veterans Affairs Medical Center, is leading a study funded by one of this year's DxQI grants into why many patients of the Veterans Affairs healthcare system fail to follow up on screening test results that are positive for signs of colorectal cancer. Colon cancer is one of the leading causes of cancer death in the US, but, he said, "with screening, these are preventable deaths."
Previous studies at Veterans Health Administration sites found that, on average, between 49 percent and 62 percent of patients who have positive fecal immunochemical test or fecal occult blood test results undergo diagnostic colonoscopies within the following six months, Larson said. At the Houston facility, that completion rate is less than 40 percent, and Larson is leading a team of doctors that are looking into why so few veterans complete the follow-up colonoscopies. That will entail mapping the process of ordering and scheduling colonoscopies, identifying barriers, and finding ways to raise the completion rate.
Larson said any improvements could potentially help thousands of patients at VA facilities and other healthcare providers.
"Making that pathway easy for the veterans, optimized, and efficient is going to save lives," he said.