UNC hematologist part of the Choosing Wisely® task force

Dr. Alice Ma, MD, from the Division of Hematology Oncology, was on the Choosing Wisely® task force for the American Society of Hematology (ASH). ASH recently released a list of the five most common hematologic tests, treatments, and procedures that should be questioned by patients and physicians.

UNC hematologist part of the Choosing Wisely® task force click to enlarge Alice Ma, MD

Wednesday, January 8, 2014

The American Society of Hematology (ASH), the world’s largest professional organization dedicated to the causes and treatments of blood disorders, has released a list of common hematology tests, treatments, and procedures that are not always necessary as part of Choosing Wisely®, an initiative of the ABIM Foundation.

"Patients may sometimes request tests that may not be indicated, and physicians may recommend procedures that are also of limited value, and this list is designed to empower patients and physicians to be better consumers of health care," said Dr. Ma. "It is not designed to limit health care, but to help patients and providers choose the best health care at the best time."

The list, also highlighted in a manuscript published online in Blood, the Journal of the American Society of Hematology, makes five evidence-based recommendations in an effort to prompt conversations between patients and physicians about the necessity and potential harm of certain practices. ASH’s Choosing Wisely list (available at  www.hematology.org/choosingwisely) identifies the following five tests, treatments, and procedures that hematologists and their patients should question:

  • Limit surveillance computed tomography (CT) scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma.
  • Don’t use inferior vena cava (IVC) filters routinely in patients with acute venous thromboembolism (VTE).
  • Do not transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac, in-patients).
  • 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).
  • Don’t administer plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists (i.e. outside of the setting of major bleeding, intracranial hemorrhage or anticipated emergent surgery).

The ASH Choosing Wisely list was developed after months of careful data analysis and review as well as input from the ASH membership, using the most current evidence about management and treatment options, with the goal of starting a conversation both within the hematology community and among physicians and their patients about quality of care.

“Hematology is a specialty with many new and increasingly expensive tests and treatments. While these new diagnostic and treatment strategies represent important advances, there is also potential to pose significant harm and cost to patients if over- or misused,” said Lisa Hicks, MD, of St. Michael’s Hospital and the University of Toronto and chair of the ASH Choosing Wisely Task Force. “The ASH Choosing Wisely list serves as a reminder to hematologists to take a step back and question whether certain routinely used procedures are really necessary, and to gradually change their practices to maximize the value of care.”

One element unique to ASH’s list is the concept of avoiding harm as the dominant guiding principle for the rigorous selection process for list items. The four other established guiding principles of the Choosing Wisely campaign are evidence, cost, frequency, and scope of practice. Therefore, those tests, procedures, or treatments deemed as increasing risk of harm were prioritized for inclusion on ASH’s Choosing Wisely list.  

“ASH has shown tremendous leadership by releasing its list of tests and procedures that are commonly performed in hematology but aren’t always necessary,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health-care system.”

Since the launch of the Choosing Wisely campaign in April 2012, 92 national and state medical specialty societies, regional health collaborative organizations, and consumer partners have joined this important conversation about appropriate care. ASH’s list is part of a third group of Choosing Wisely lists that have been or will be released by more than 30 specialty societies between August 2013 and early 2014. Taken as a whole, these lists identify more than 250 tests and procedures that physicians and patients should discuss before ordering. 

The campaign continues to reach millions of consumers nationwide through a stable of consumer and advocacy partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations.

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them,visit www.ChoosingWisely.org.


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