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Choosing Wisely® Initiative Improves Quality and Cost of Care

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Key Points

  • Some routinely used tests, treatments, and procedures are not necessary and/or may cause harm.
  • Hematologists should question the use of five tests, treatments, and CT imaging procedures, according to evidence-based recommendations from an ASH Task Force initiative.
  • This list is part of a broader nationwide Choose Wisely initiative aimed at improved quality of care and appropriate use of available treatments and technology.

Five commonly used hematology tests, treatments, and procedures are not always necessary, according to the Choosing Wisely® initiative of the ABIM (American Board of Internal Medicine) Foundation. The American Society of Hematology (ASH) Choosing Wisely list of these five tests was published online in Blood to coincide with the unveiling of the list at a press conference during the 55th ASH Annual Meeting and Exposition.

“The Institute of Medicine estimated that in 2009, $750 billion USD was wasted in health care. Of this, they estimated that $210 billion was spent on unnecessary health-care services across all specialties. If we could redirect even a fraction of this to real people with real unmet health-care needs, think of the good that we could do,” said ASH’s Choosing Wisely Task Force Chair Lisa Hicks, MD, of St. Michael’s Hospital and the University of Toronto, Canada.

ASH Recommendations

Appropriate evidence-based care should consider the following:

  1. Computed tomography (CT) scans should be limited in asymptomatic patients following curative-intent treatment for aggressive lymphoma.
  2. Inferior vena cava filters should not be routinely used in patients with acute venous thromboembolism.
  3. Do not transfuse more than the minimum number of red blood cell units necessary to relieve symptoms of anemia or to return a patient to safe hemoglobin range (7–8 g/dL in stable noncardiac inpatients).
  4. Do not test for thrombophilia in adults with venous thromboembolism occurring in the setting of major transient risk factors such as surgery, trauma, or prolonged immobility.
  5. Do not administer plasma or prothrombin complex concentrates for nonemergent reversal of vitamin K antagonists (ie, outside the setting of major bleeding, intracranial hemorrhage, or anticipated emergent surgery).

These evidence-based recommendations were developed over months of careful data analysis and review by the ASH Choosing Wisely Task Force with input from ASH membership. The goal was to start a conversation within the hematologic community and among physicians and their patients about quality of care.

The dominant principle of these recommendations is to avoid harm, hearkening back to the Hippocratic oath. Other guiding principles include evidence, cost, frequency, and scope of practice. The ASH Task Force prioritized the tests, procedures, or treatments considered to increase the risk of harm for inclusion in the Choosing Wisely list.

The list developed by ASH is part of a third group of Choosing Wisely lists that have been or are planned to be released by more than 30 medical specialty societies over the next few months. In total, these lists cite more than 250 tests and procedures that should be discussed with patients before physicians order them.

Hematology, like other medical specialties, has many new and increasingly expensive tests and treatments. “These new diagnostic and treatment strategies represent important advances, but there is also potential to pose significant harm and cost to patients if over- or misused,” Dr. Hicks stated.

For a look at the list, see www.hematology.org/choosingwisely.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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