Mayo Clinic proceedings. Innovations, quality & outcomes最新文献

{"title":"A Multifunction Neurosciences Intensive Care Unit Lumbar Puncture Service Improves Efficiency and Delivers Significant Cost Savings","authors":"Mutaz Ombada MD,&nbsp;W. David Freeman MD,&nbsp;Perry S. Bechtle Jr. DO,&nbsp;Lauren K. Ng MD, MPH,&nbsp;Devang K. Sanghavi MBBS, MD,&nbsp;Pablo Moreno Franco MD","doi":"10.1016/j.mayocpiqo.2026.100738","DOIUrl":"10.1016/j.mayocpiqo.2026.100738","url":null,"abstract":"<div><h3>Objective</h3><div>To enhance the multifunctional efficacy and cost efficiency of lumbar puncture (LP) services for optimal patient outcomes.</div></div><div><h3>Patients and Methods</h3><div>In January 2023, the neurosciences intensive care unit (NeuroICU) created a day team (Team 2) to offload time-sensitive tasks from the 24-hour service team (Team 1). We hypothesized that a multifunction service would improve operational efficiency and generate meaningful cost savings. We performed a single-center, retrospective review of Team 2 activities from January 21, 2023, to April 21, 2025, at Jacksonville campus of Mayo Clinic Florida, encompassing 400 consult encounters across 7 multifunction service domains. We determined cost savings using a time-driven, activity-based costing method, which estimated bed-day savings using a $2500/day cost and average 2-day hospital length-of-stay reduction with earlier intervention.</div></div><div><h3>Results</h3><div>During the study period, a total 200 LPs were performed, creating an estimated cost savings of $1 million. Team 2 completed around 100 LPs/year vs 23/year with the previous model, reducing length of stay by 2 days per LP (∼$5000/patient; ∼$500,000/year). This led to earlier postoperative discharges, as early as the day of the LP in some cases. These collective functions similarly streamlined care pathways, fostering bed availability, and led to earlier discharge of patients needing LP consult and those in the primary postoperative NeuroICU using an early discharge process.</div></div><div><h3>Conclusion</h3><div>A multifunctional NeuroICU day team yielded measurable throughput gains and substantial direct cost savings, as well as added team operational resilience.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 4","pages":"Article 100738"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148625274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotyping Heart Failure: Looking Beyond Left Ventricular Ejection Fraction","authors":"Awais A. Malik MD","doi":"10.1016/j.mayocpiqo.2026.100746","DOIUrl":"10.1016/j.mayocpiqo.2026.100746","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 4","pages":"Article 100746"},"PeriodicalIF":4.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Code Intracerebral Hemorrhage: A Quality Improvement Pilot Study","authors":"Ehab Harahsheh MBBS ,&nbsp;Oana M. Dumitrascu MD, MSc ,&nbsp;Katelyn Marsden MBBS, MSc ,&nbsp;Vanesa K. Vanderhye MSN ,&nbsp;Justin Cramer MD ,&nbsp;Cumara B. O’Carroll MD, MPH","doi":"10.1016/j.mayocpiqo.2025.100690","DOIUrl":"10.1016/j.mayocpiqo.2025.100690","url":null,"abstract":"<div><h3>Objective</h3><div>To improve adherence to current national guideline-recommended practices for managing acute spontaneous intracerebral hemorrhage (ICH) in patients presenting to Mayo Clinic Arizona emergency department.</div></div><div><h3>Patients and Methods</h3><div>We launched a quality improvement initiative from April 1, 2024, to April 30, 2025, using the Define-Measure-Analyze-Improve-Control framework. Initial 6-month goals included: (1) administering antihypertensive treatment within 30 minutes of identifying ICH in ≥80% of patients with systolic blood pressure &gt;150 mm Hg; (2) reversing anticoagulation within 45 minutes in ≥80% of anticoagulated patients; (3) performing repeat computed tomography head scans at 6 hours post-ICH identification in ≥80% of patients; and (4) initiating vascular neurology and neurosurgery assessments within 15 minutes of ICH recognition. Identified care gaps, informed by stakeholder feedback, led to the creation of a standardized Code ICH protocol and an emergency department-specific ICH electronic medical record power plan.</div></div><div><h3>Results</h3><div>Twenty patients were included in the 1-6-month interval (Code ICH activated in 15/20 (75%) of eligible patients) and 12 patients in the 7-13 month interval (Code ICH activated in 8/12 [67%]). Antihypertensive medication administration within 30 minutes occurred in 92% (11/12) and 100% (3/3) of patients with systolic blood pressure &gt;150 mm Hg. Anticoagulation reversal within 45 minutes was achieved in all eligible patients (100%, 2/2). Repeat computed tomography scans at 6 hours post-ICH identification were completed in 93% (11/12) and 100% (8/8) of patients at respective time points. Immediate vascular neurology evaluations were performed in all patients, and neurosurgery consultations occurred in 87% (20/23). A sustainability plan was developed postintervention to maintain continued Code ICH activation and compliance.</div></div><div><h3>Conclusion</h3><div>Implementation of a structured Code ICH protocol facilitated prompt neurological assessments and adherence with current national acute ICH management guidelines.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100690"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of a Remote Patient Care Program on Health Care Costs and Utilization Among Medicare Patients With Chronic Disease","authors":"David I. Feldman MD, MPH ,&nbsp;Spencer Reynolds MBA ,&nbsp;Sarine Babikian PhD ,&nbsp;Brian D. Stein MD, MS ,&nbsp;Jessica Schlicher MD, MBA ,&nbsp;Eve Cunningham MD, MBA ,&nbsp;Theodore Feldman MD ,&nbsp;Randall Curnow MD, MBA ,&nbsp;Jing Zheng MS ,&nbsp;Puneet Budhiraja MS ,&nbsp;Marat Fudim MD, MHS","doi":"10.1016/j.mayocpiqo.2025.100679","DOIUrl":"10.1016/j.mayocpiqo.2025.100679","url":null,"abstract":"<div><div>Remote patient monitoring coupled with technology-enabled, guideline-directed clinical care—or remote patient care (RPC)—has consistently led to improved outcomes for Medicare patients with chronic diseases. However, the ability for RPC to drive reductions in total cost of care and health care utilization is limited. We sought to determine whether an RPC program can reduce health care costs and utilization. Using patient-level Medicare claims data, a difference in difference analysis was conducted to assess the impact of an RPC program compared with a propensity score–matched control group on total health care costs and resource utilization over a 12-month period following program activation. The retrospective analysis included patients enrolled into an RPC program from July 1, 2022 to October 31, 2023 from primary care and cardiology clinics across 15 states. The RPC program included a group of clinicians who monitored and triaged vitals and conducted clinical visits using standardized clinical protocols to facilitate guideline-directed clinical interventions. We compared 5872 patients enrolled in an RPC program to 11,449 eligible propensity score–matched control patients. RPC resulted in a statistically significant reduction in total cost of care (−$1302 per patient per year; <em>P</em>&lt;.01), which was driven primarily by a reduction in inpatient costs (−$1428 per patient per year; <em>P</em>&lt;.01). Patients enrolled in the RPC program also had a lower rate of hospitalizations (−23 vs +41/1000 patients/y; 27% reduction; <em>P</em>&lt;.01). These data highlight the potential for a nationwide RPC program to lead to significant cost savings and a reduction in health care utilization among Medicare patients at scale.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100679"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Change in Vitamin D Status and its Association With Change in Total Hip Bone Mineral Density in Older Women: A Population-Based Cohort Study","authors":"Karl Michaëlsson PhD ,&nbsp;Håkan Melhus PhD ,&nbsp;Liisa Byberg PhD ,&nbsp;Eva Warensjö Lemming PhD ,&nbsp;Bodil Svennblad PhD ,&nbsp;Jonas Höijer MSc ,&nbsp;Hannah L. Brooke PhD","doi":"10.1016/j.mayocpiqo.2025.100681","DOIUrl":"10.1016/j.mayocpiqo.2025.100681","url":null,"abstract":"<div><h3>Objective</h3><div>To examine if long-term constant low vitamin D status in the sunny season has a greater impact on bone mineral density (BMD) over time than long-term constant low vitamin D status in the dark season.</div></div><div><h3>Patients and Methods</h3><div>In a longitudinal cohort study conducted from November 3, 2003 to May 22, 2019, 1802 Swedish women living in Uppsala County (latitude 58^oN) (mean baseline age of 65 years and average follow-up of 12 years) had vitamin D status measured by serum 25-hydroxyvitamin D concentration (S-25OHD). Participants were stratified by season of blood draw (dark [November-April] vs sunny [May-October]). We examined the association of long-term stable season-specific S-25OHD with 12-year changes in total hip BMD, measured by dual-energy x-ray absorptiometry, and investigated if increasing S-25OHD during follow-up influenced changes in BMD by baseline S-25OHD levels and season.</div></div><div><h3>Results</h3><div>Compared with longitudinally sunny season constant S-25OHD&gt;70 nmol/L, women with sunny season constant S-25OHD&lt;40 nmol/L displayed 10.0% (95% CI,3.8%-16.1%) lower total hip BMD at follow-up. No difference in BMD was observed by dark season S-25OHD. Among women with baseline sunny season S-25OHD&lt;45 nmol/L, each 20 nmol/L increase in S-25OHD during follow-up was associated with a 2.5% increase in hip BMD (95% CI,0.5-4.6). This estimate was attenuated when increasing the low S-25OHD cut-off and was not observed with dark season samples.</div></div><div><h3>Conclusion</h3><div>Women with sunny season S-25OHD&lt;40-50 nmol/L are a likely target group for vitamin D interventions to improve BMD. Blood samples taken during the dark season are less informative for determining future bone health.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100681"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifeature Ultrasound-Based Classification for Breast Lesions: A Comparative Study of PONS Image Enhancement Technology","authors":"Sabahattin M. Daloglu MPhil ,&nbsp;Ceren Coskun BSc ,&nbsp;Gokce Bekar MSc ,&nbsp;Senanur Sahin BSc ,&nbsp;Haley P. Letter MD ,&nbsp;Harvey Castro MD ,&nbsp;Soner Hacihaliloglu MBA ,&nbsp;Ilker Hacihaliloglu PhD","doi":"10.1016/j.mayocpiqo.2025.100691","DOIUrl":"10.1016/j.mayocpiqo.2025.100691","url":null,"abstract":"<div><h3>Objective</h3><div>To overcome critical limitations of B-mode ultrasound in artificial intelligence diagnostics—including poor image quality and operator variability—by developing a multifeature framework that combines raw B-mode scans with 2 optimized representations (enhanced ultrasound and quality-improved ultrasound) for robust breast cancer classification.</div></div><div><h3>Patients and Methods</h3><div>We conducted a retrospective study of 62,912 breast ultrasound scans (100%) from 688 patients (100%) at the Mayo Clinic (from December 01, 1989 to March 30, 2024). The study compared 3 deep learning architectures—graph convolutional networks (GCNs), masked autoencoders (MAEs), and multi-scale convolutional neural network (MSCNN)—using either standard B-mode inputs alone or combined with our enhanced features. Performance was evaluated through 3-fold cross-validation at the patient-level, with primary metrics including accuracy, area under the curve, F1-score, sensitivity, and specificity.</div></div><div><h3>Results</h3><div>The multifeature approach reported substantial improvements across all metrics. For GCNs, multifeature integration increased accuracy from 0.508 to 0.845 and F1-score from 0.067 to 0.835. Sensitivity improved dramatically from 5.6% to 91.7%, while specificity showed a modest decrease from 85.7% to 79.0%. The MAE models showed different but complementary strengths, with multifeature integration improving accuracy from 0.775 to 0.873, F1-score from 0.785 to 0.822, and achieving perfect specificity (100%) while maintaining clinically acceptable sensitivity (71.1%). The MSCNN, included as a baseline convolutional architecture, showed minimal improvement with multifeature integration, with accuracy increasing slightly from 0.571 to 0.585 and specificity from 0.667 to 0.819. These results highlight the superior capability of GCNs and MAEs to effectively leverage multifeature information in breast ultrasound analysis compared with conventional MSCNN.</div></div><div><h3>Conclusion</h3><div>PONS-enhanced multifeature ultrasound significantly improves breast cancer detection accuracy versus B-mode alone, offering complementary clinical solutions: GCNs for high sensitivity screening (91.7%) and MAEs for high-specificity diagnosis (100%). Results demonstrate clinical potential across diverse populations, with future work exploring enhanced fusion strategies.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100691"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Masked Intruder: Extranodal Natural Killer/T-Cell Lymphoma Mimicking Preseptal Cellulitis","authors":"Shane A. Fuentes MD ,&nbsp;Gregory J. Griepentrog MD ,&nbsp;Rebecca L. King MD ,&nbsp;N. Nora Bennani MD ,&nbsp;Supavit Chesdachai MD","doi":"10.1016/j.mayocpiqo.2025.100689","DOIUrl":"10.1016/j.mayocpiqo.2025.100689","url":null,"abstract":"<div><div>Extranodal natural killer/T-cell lymphoma is a rare, aggressive, Epstein-Barr virus-associated malignancy. We reported an unusual case of a woman in her middle 40s presenting with progressive left-sided periorbital swelling, redness, and pain, initially treated as a refractory preseptal cellulitis. Despite aggressive antibiotic therapy, symptoms worsened. Imaging showed inflammatory stranding and phlegmonous enhancement involving the left orbit. A biopsy revealed the diagnosis of primary orbital extranodal natural killer/T-cell lymphoma (nasal type) without sinonasal involvement, which is extremely uncommon. This case emphasized the need to consider other noninfectious diagnoses in patients with preseptal cellulitis unresponsive to antibiotics.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100689"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Identifying and Overcoming Barriers to CAR-T Access Through Streamlined and Standardized Pathways","authors":"Kanishka Uttam Chandani MBBS,&nbsp;Nandita Khera MD, MPH","doi":"10.1016/j.mayocpiqo.2025.100693","DOIUrl":"10.1016/j.mayocpiqo.2025.100693","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100693"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organic Pollutants and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis","authors":"Yousif M. Hydoub MBBS ,&nbsp;Ricardo Loor-Torres MD ,&nbsp;Abdul Qadeer MBBS ,&nbsp;Kinaan Farhan MBBS ,&nbsp;Thaer K. Swaid MBBS ,&nbsp;Hanieh Sadat Tabatabaei Yeganeh MBBS ,&nbsp;Joelle N. Friesen MD ,&nbsp;Shangwe Kiliaki CNP, DNP ,&nbsp;Iman Fawad MBBS ,&nbsp;Danielle J. Gerberi MLIS, AHIP ,&nbsp;Thirumurugan Prakasam PhD ,&nbsp;Rainer Lohmann PhD ,&nbsp;M. Hassan Murad MD, MPH ,&nbsp;Sagar B. Dugani MD, PhD, MPH","doi":"10.1016/j.mayocpiqo.2025.100677","DOIUrl":"10.1016/j.mayocpiqo.2025.100677","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the associations between organic pollutants (OPs) and risk of type 2 diabetes (T2D).</div></div><div><h3>Patients and Methods</h3><div>We searched Medline, Embase, Scopus, Web of Science, and Cochrane Central from inception through March 18, 2024. We included studies reporting the adjusted or unadjusted association between serum concentration of OPs and risk of T2D. We excluded studies on type 1 diabetes, self-reported exposure, and if fewer than 100 T2D cases. We classified OPs using 2 classification methods and reported pooled risk estimates using a random-effects model (odds ratio [95% CI]) and assessed risk of bias at the levels of OPs and their classes. We conducted sex- and concentration-stratified analyses.</div></div><div><h3>Results</h3><div>From 20,531 articles, we included 44 (0.2%) studies of 83 individual and 38 combination OPs in 54,967 participants. All but 1 study had low risk of bias. Ten of 12 OP classes were associated with risk of T2D, polychlorinated dibenzo-p-furans had the highest association (OR, 2.54; 95% CI, 1.94-3.33). Polychlorinated dibenzo-p-dioxins showed a significant association in men (OR, 3.21; 95% CI, 1.81-5.71). Polychlorinated biphenyls (OR, 1.72; 95% CI, 1.55-1.92) and dichlorodiphenyltrichloroethane (DDT) and DDT-like compounds (OR, 1.14; 95% CI, 1.01-1.29) showed a significant association in women. Moreover, 28 (33.7%) individual and 21 (55.3%) combination OPs had a significant association. Polychlorinated biphenyl 157 (OR, 1.93; 95% CI, 1.27-2.92) and organochlorine pesticides (OR, 4.35; 95% CI, 1.90-9.98) had the highest risk of T2D.</div></div><div><h3>Conclusion</h3><div>Several OPs were associated with higher risk of T2D. Future work should evaluate the concentration threshold at which OPs increase risk to inform both T2D screening and OP advisories and regulation.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100677"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operationalizing Access for Chimeric Antigen Receptor T cell Therapies: A Cross-functional Perspective","authors":"Surya Singh MD ,&nbsp;Carol Greulich MBA ,&nbsp;Ariel Perez MD ,&nbsp;Kelly Terrell MBA, BSN ,&nbsp;Julie Walz-Jensen BS, RN ,&nbsp;Michael D. Dalzell BA","doi":"10.1016/j.mayocpiqo.2025.100682","DOIUrl":"10.1016/j.mayocpiqo.2025.100682","url":null,"abstract":"<div><div>Chimeric antigen receptor T cell (CAR T) treatment efficacy has been shown to be greater in those who receive timely infusions, while mortality rates increase with each month’s delay in treatment. Yet health care infrastructure constraints, an intricate treatment process, and reimbursement complexities present challenges that affect timely patient access to CAR T therapy. Best practices for decreasing time to treatment are not well established. Autolus Inc convened an expert panel of 3 advisors from established hematopoietic stem-cell transplant centers and 3 advisors with extensive national or regional payer experience to identify operational barriers that contribute to treatment delays as well as potential means for addressing them. Opportunities exist to expand treatment capacity by reducing redundant prerequisites for treatment center certification and through collaboration between established centers and newer centers that need critical expertise to gain accreditation. Aligning clinical criteria are important for improving clinician understanding of the treatment process, facilitating timely referral to treatment centers, and streamlining payer authorization processes. Negotiating financial arrangements is the most time-consuming step of the process before CAR T manufacturing can begin; contracts between treatment centers and payers can help to facilitate timely care, but single-case agreements are necessary for treatment centers and payers without extensive CAR T experience. Single-case agreements should consider each side’s experience and financial exposure. In identifying obstacles to timely care and working through potential solutions, participants developed a genuine appreciation for the interdependence among stakeholders. Recognition of mutual interest is a starting point for cross-functional cooperation.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"10 1","pages":"Article 100682"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}