ASH acknowledges three Choosing Wisely Champions for their ‘elegant, implementable strategies’
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ORLANDO — ASH named three Choosing Wisely Champions today at its Annual Meeting and Exposition, recognizing clinicians who have implemented projects to improve quality and reduce costs at their institutions.
The American Board of Internal Medicine Foundation’s Choosing Wisely campaign aims to reduce expenses without decreasing quality of care. It also encourages conversations between patients and clinicians about the necessity and potential harm of certain procedures.
As part of the Choosing Wisely initiative, ASH has identified 15 tests, treatments and procedures commonly used in hematology that clinicians and patients should question before using to avoid overuse, waste and harm.
“Choosing Wisely is an opportunity to highlight great implementation efforts that help improve the quality of care for our patients and to honor individuals who dedicated time and research to tackle different types of overutilization with elegant, implementable strategies,” Anita Rajasekhar, MD, of University of Florida and chair of the ASH subcommittee on stewardship and systems-based hematology, which selected the winners, said in a press release. “Education alone and awareness alone are not enough, and so I have no doubt that these three exemplary champions will motivate others to follow their lead.”
This year’s Choosing Wisely Champions include:
- Stephen L. Wang MD, of Kaiser Permanente Santa Clara Medical Center, for his project, “Reduction in IVCF Utilization and Increase in IVCF Retrievals.”
Wang and colleagues orchestrated a grand rounds educational campaign at 14 U.S. medical centers regarding the efficacy of inferior vena cava filters (IVCF), guidelines on their use and associated complications. Researchers tracked IVCF use, rates of retrieval and fulfillment of guidelines for 12 months before and after intervention and found that after the campaign, IVCF use decreased and retrieval increased.
- Rachael Grace, MD, of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, for her project, “Recommendations for Newly Diagnosed Children with Immune Thrombocytopenia (ITP).”
Grace and colleagues developed a second iteration of guidelines that support an observational approach for children newly diagnosed with ITP. The modification — which stratified low- and high-risk grade 3 bleeding — led to an increase in observation rates from 40% to 74%, with no increase in bleeding events.
- Jordan Schaefer, MD, of University of Michigan, Ann Arbor, for his project, “Warfarin Monotherapy in Place of Combination Therapy of Aspirin and Warfarin.”
Six participating sites developed a tailored screening process to identify potentially inappropriate aspirin use, which would then prompt the patient’s primary care provider to conduct a discussion with the patient about their aspirin use. Sites assessed their inappropriate aspirin use monthly, and these experiences were used to create an anticoagulation toolkit.
In addition, ASH and the American Society of Pediatric Hematology/Oncology today released a list of five evidence-based recommendations to reduce the use of unnecessary tests and procedures in the pediatric population.
These recommendations encourage hematologists to not:
perform routine preoperative hemostatic testing in a child with no prior personal or family history of bleeding;
transfuse platelets in an asymptomatic child with a platelet count greater than 10,000/mcL unless other signs and/or symptoms for bleeding are present, or if the patient is to undergo an invasive procedure;
order thrombophilia testing for children with venous access-associated thrombosis in the absence of a positive family history;
transfuse packed red blood cells for iron deficiency anemia in asymptomatic pediatric patients without evidence of hemodynamic instability or active bleeding; and
routinely administer granulocyte colony stimulating factor for empiric treatment of children with asymptomatic autoimmune neutropenia in the absence of recurrent or severe bacterial or fungal infections.
“I have been involved with ASH’s efforts within the Choosing Wisely campaign for several years, and as a pediatric hematologist it is very exciting to see a list focused on the unique needs of our patient population,” ASH co-chair Sarah O’Brien, MD, of Nationwide Children’s Hospital, said in a press release. “The true excitement is to come, though, as this new list is disseminated among the pediatric hematology community. It is my hope that providers will pick an item that particularly resonates with them, and then teach this best practice to their colleagues not only within hematology, but also in other relevant specialties. It is through these ‘boots on the ground’ efforts in the Choosing Wisely campaign that we will truly make big strides in patient/family satisfaction, safety and quality of care.”
References:
ASH Choosing Wisely® Campaign: 2019 ASH Choosing Wisely Champions. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2019; Orlando.
ASH Choosing Wisely® Campaign: The ASH-ASPHO Pediatric Choosing Wisely List. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2019; Orlando.
Disclosures: Grace reports consultant/advisory roles with and researching funding from Agios Pharmaceuticals, a consultant role with Dova, and research funding from Novartis. O’Brien, Schaefer and Wang report no relevant financial disclosures.