Matthew Nielsen, MD, MS, chair of urology and member of the Lineberger Comprehensive Cancer Center, was selected by the National Academy of Medicine (NAM) to participate in the 2024 class of the NAM Scholars in Diagnostic Excellence program.
Matthew Nielsen, MD, MS, chair of urology and member of the Lineberger Comprehensive Cancer Center, was selected by the National Academy of Medicine (NAM) to participate in the 2024 class of the NAM Scholars in Diagnostic Excellence program.
In the wake of the National Academies of Science, Engineering and Medicine’s 2015 consensus report, Improving Diagnosis in Health Care, the concept of Diagnostic Excellence has emerged as a model to support the delivery of effective, patient-centered care of the highest quality. As defined by Yang et al. in their seminal JAMA publication, “diagnostic excellence refers to an optimal process to attain an accurate and precise explanation about a patient’s condition. An optimal process would be timely, cost-effective, convenient, and understandable to the patient. An accurate and precise diagnosis gains clinical value insofar as it leads to better choices in treatment.”
The 2015 NASEM report identified many opportunities to improve diagnosis in patients’ journeys within and across medical disciplines. Given the absence of a corresponding medical specialty, urology is relatively unique among surgical specialties, with a breadth of diagnostic processes for prevalent conditions bridging primary care and specialist practice.
In his role as Chair of the Science and Quality Council for the American Urological Association (AUA), Nielsen is leading AUA’s efforts to advance Diagnostic Excellence in the specialty, supported by funding from the Council of Medical Specialty Societies and the John Hartford Foundation. In this project, AUA is developing broad educational activities related to Diagnostic Excellence in urology, with particular focus on opportunities to reduce disparities in prostate cancer diagnosis and outcomes among Black men in the U.S. through precision screening strategies with the prostate-specific antigen (PSA) blood test, in partnership with primary care physicians.
Nielsen’s proposal for the NAM program focuses on the next steps downstream from the initial PSA screening test. This effort will leverage innovative programs optimizing the quality of prostate MRI, in partnership with radiologists, and novel MRI-targeted “fusion” biopsy, building on the UNC’s participation in nationally recognized improvement collaboratives in the space. Taken together, this body of work will bring to scale a systematic strategy to improve quality and address historical disparities in the early detection of prostate cancer, as an initial step towards the goal of advancing Diagnostic Excellence across a broader range of conditions. Alongside these efforts, he serves on the National Quality Forum’s Diagnostic Excellence Committee, developing novel performance measures related to this topic.