Choosing Wisely Champions" Share Their Practice-Changing Success"/> Choosing Wisely Champions" Share Their Practice-Changing Success" />
Currently Viewing:
Evidence-Based Oncology January 2017
CAR-T Cells of Defined Composition Effective in Ibrutinib-Refractory CLL
Surabhi Dangi-Garimella, PhD
Cytokine Biomarkers Can Predict Response to CAR T-Cell Treatment in CLL
Surabhi Dangi-Garimella, PhD
Phase 3 LyMa Trial: Rituximab After ASCT Increases OS in Mantle Cell Lymphoma
Surabhi Dangi-Garimella, PhD
Early Results Show Palbociclib Helps Sustain Patient Response to Ibrutinib in MCL
Surabhi Dangi-Garimella, PhD
RESONATE-2 Continues to Impress With Single-Agent Ibrutinib for CLL/SLL at 29 Months
Surabhi Dangi-Garimella, PhD
Phase 3 GALLIUM Study Shows Promising Results With Obinutuzumab for Follicular Lymphoma
Christina Mattina
Ibrutinib Prevents Cytokine-Release Syndrome After CAR T-Cell Therapy for B-Cell Neoplasms
Christina Mattina
Prior Ibrutinib Treatment Improves CAR T-Cell Expansion, Could Impact Response in CLL
Surabhi Dangi-Garimella, PhD
How Soon Will Pluripotent Stem Cells Find Clinical Utility?
Surabhi Dangi-Garimella, PhD
ASH Symposium on Quality Addresses Health IT Challenges for the Provider and the Patient
Surabhi Dangi-Garimella, PhD
Incorporating Nurse Specialists Into Hematology Care: Improved QOL for Patient and Provider
Surabhi Dangi-Garimella, PhD
Currently Reading
ASH "Choosing Wisely Champions" Share Their Practice-Changing Success
Surabhi Dangi-Garimella, PhD
Healthcare Costs and Utilization After First-Line Therapy for Medicare DLBCL Patients
Christina Mattina
Model to Predict Disease Complexity and Costs Associated With AHCT in Acute Leukemia
Surabhi Dangi-Garimella, PhD
Healthcare Utilization and Costs Associated With the Treatment of Relapsed/Refractory MM
Surabhi Dangi-Garimella, PhD
Innovative Approach to Precision Trial Design: NCI-MATCH and Beat AML
Surabhi Dangi-Garimella, PhD

ASH "Choosing Wisely Champions" Share Their Practice-Changing Success

Surabhi Dangi-Garimella, PhD
At the 2016 annual meeting, the American Society of Hematology introduced the “Choosing Wisely Champions” to recognize the efforts of practitioners who are working to eliminate costly and potentially harmful overuse of tests and procedures.
IN COOPERATION WITH THE AMERICAN BOARD of Internal Medicine Foundation, the American Society of Hematology (ASH) introduced the “Choosing Wisely Champions” to recognize the efforts of practitioners who are working to eliminate costly and potentially harmful overuse of tests and procedures. These winners were invited to showcase their work at the 58th Annual Meeting & Exposition of ASH to provide attendees with an opportunity to learn and potentially implement these changes in their own practices. The session was chaired by Lisa K. Hicks, MD, oncological hematologist at St. Michael’s Hospital, Toronto, Canada.

Ravindra Sarode, MD, medical director of clinical laboratory services, University of Texas Southwestern Medical Center, Dallas, Texas, spoke during the session, “Reduction in Unnecessary or Misapplied Thrombophilia Testing in Patients with DVT, PE, or Other Thrombotic Disorders Using Combination of Education and EMR Alerts. “The ASH Choosing Wisely guiding principles aim to reduce harm to patients, reduce costs, and are within the clinical domain of hematology,” Sarode said. For his presentation, Sarode referred to recommendation 2 by ASH:

Don’t test for thrombophilia in adult patients with venous thromboembolism (VTE) occurring in the setting of major transient risk factors (surgery, trauma, or prolonged immobility).1

“Unfortunately, there are no thrombophilia-testing guidelines,” he told the audience. “Why, whom, what, and when to test are always open-ended questions.” Confusion over whether testing should be done in-house and the lack of testing guidelines in the adult and pediatric populations make for complicated decisions on testing.

Unnecessary testing can result in serious harm because of the following:
  1. Testing is often conducted in provoked venous thromboembolism (VTE) during an acute event of anticoagulation
  2. VTE testing often yields false-positive results
  3. Testing often results in an unnecessary increase in healthcare costs
At their healthcare center, Sarode and his team analyzed consecutive thrombophilia testing orders during October and November of 2009, based on electronic health records (EHRs).2 They evaluated indication, timing, comprehensiveness of tests, anticoagulation therapy at the time of testing, and confirmatory repeat testing, if any. Of the 173 patient records that were evaluated, a majority (72%) of patients were female.
  • 70% had VTE or pregnancy loss (34%, unprovoked VTE or >3 pregnancy losses; 35%, provoked VTE; 31%, no documented reason)
  • 51% were tested within 7 days of an index clinical event
  • 51% were tested on anticoagulation therapy results affected by anticoagulation therapy
  • 16% had a complete work-up with 1 work draw
  • 84% had incomplete or fragmented testing, including unnecessary blood draws, which was a waste of time for the nurse and the technician
  • 46% had abnormal results, and only 46% of these had abnormal tests repeated for confirmation; 54% potentially had a wrong diagnosis with long-term anticoagulation.
“We estimated a conservative loss of $1 million annually, over and above the incalculable loss of unnecessary long-term anticoagulation and related complications,” Sarode said. “We implemented local guidelines for thrombophilia testing for clinicians, resulting in a reduction in healthcare costs and improved patient care. Twenty-two months after guideline implementation, a 92% reduction in testing was observed.” However, the process was fraught with challenges, and communication was key, he acknowledged, which included verbal communication through meetings and grand rounds as well as changes within the Epic EHR system to flag testing each time it was ordered.

Maria I. Juarez, MD, from the Cancer Institute of Dallas, Mansfield, Texas, spoke during “Reduction of RBC Transfusion Via Updated Guidelines, Modified Workflow, and Physician Education.” She detailed the project at their cancer institute that addressed recommendation 1 by ASH:



 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!