ASH releases new ‘Choosing Wisely’ recommendations

ASH today identified several treatments, tests and procedures for hematologic conditions that physicians and patients should question.

The recommendations, the second set ASH has released as part of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign, are:

Do not treat a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor with an anticoagulant for more than 3 months;
Do not routinely transfuse patients with sickle cell disease for uncomplicated pain crisis or chronic anemia without an appropriate clinical indication;
Do not perform baseline or routine surveillance CT scans in patients with asymptomatic, early-stage chronic lymphocytic leukemia;
Do not test or treat for suspected heparin-induced thrombocytopenia in patients with a low pre-test probability of the condition; and
Do not treat patients with immune thrombocytopenic purpura in the absence of bleeding or a very low platelet count.

The ABIM Foundation launched the Choosing Wisely campaign in 2012 as part of an effort to reduce wasteful spending without sacrificing quality care.

More than 100 entities — including ASH, ASCO, the American Society for Radiation Oncology and the Society of Gynecologic Oncology — participate in the program, through which they identify treatments and procedures that are frequently offered but are not supported by evidence. In some cases, the potential harms outweigh the benefits.

The new ASH list was created through a process of evidence-based methodology. The recommendations, which include suggestions from ASH members, prioritize the need to avoid harming patients above any other consideration.

“Unnecessary treatment or tests not only add waste to the health care system, but in some cases they also expose our patients to a risk of harm,” Lisa Hicks, MD, of St. Michael’s Hospital and the University of Toronto and chair of ASH’s Choosing Wisely Task Force, said in a press release. “ASH developed its second ‘Choosing Wisely’ list to help hematologists manage the utilization and delivery of patient-care resources … The society encourages hematologists to consider these recommendations in all facets of their work, including patient care, teaching, innovation and research.”

Lisa Hicks

Hicks and other ASH members who helped develop the recommendations will discuss them in greater detail during a session as the ASH Annual Meeting and Exposition, scheduled for Dec. 5-9 in San Francisco.

The primary guiding principle ASH has used during its Choosing Wisely effort is to avoid harm. Other principles have included strength of evidence, aggregate cost, frequency and making recommendations within the purview of hematology.

ASH’s task force added a new principle — potential impact in the field — to its objectives this year.

“[This initiative] set out to stimulate conversations about waste and overuse in our health care system,” Richard J. Baron, MD, president and CEO of the ABIM Foundation, said in a press release. “ASH’s second … list gives clinicians and patients a new and important tool to help inform their conversations about what care is best for the patient.”