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ASH releases second list of five tests and treatments to question in hematology

The American Society of (ASH), the world’s largest professional organization dedicated to the causes and treatments of blood disorders, today named five additional commonly used tests, treatments, and procedures in that physicians and patients should question in certain circumstances. The additional items join an initial list of five practices to question that the Society released last year as part of the Choosing Wisely® campaign, an initiative of the that aims to prompt between patients and physicians about the necessity and potential harm of certain procedures. These new practices to question are also highlighted in a manuscript published this week in Blood, the Journal of the American Society of , which further describes the methods in development of the list and the evidentiary basis of the recommendations.

ASH’s new Choosing Wisely recommendations (available at http://www.hematology.org/choosingwisely) include:

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

The second ASH Choosing Wisely list was developed using a rigorous evidence-based methodology that incorporated suggestions from ASH members and prioritized avoiding harm to patients above all other considerations. The goal of the list is to start conversations both within the hematology community and among physicians and their patients about how everyone can maximize the quality of hematologic care.

“Unnecessary treatments 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,” said Lisa Hicks, MD, of St. Michael’s Hospital and the University of Toronto and chair of the ASH Choosing Wisely Task Force. “ASH developed its second Choosing Wisely list to help hematologists manage the utilization and delivery of patient-care resources, and the Society encourages hematologists to consider these recommendations in all facets of their work including patient care, teaching, innovation, and research.”

The dominant guiding principle for ASH’s list is the concept of avoiding harm. The four other established guiding principles of ASH’s involvement in the Choosing Wisely campaign are strength of evidence, aggregate cost, frequency, and making recommendations within the purview of hematology. This year, the Task Force added a sixth overarching principle of potential impact in the field.

“Choosing Wisely set out to stimulate conversations about waste and overuse in our health-care system. We’ve been fortunate to be joined in this effort by many dedicated partners – including ASH – who have committed to addressing unnecessary care in their specialty,” said Richard J. Baron, MD, President and CEO of the ABIM Foundation. “ASH’s second Choosing Wisely list gives clinicians and patients a new and important tool to help inform their conversations about what care is best for the patient.”

Since the launch of the Choosing Wisely campaign in April 2012, more than 100 national and state medical specialty societies, regional health collaborative organizations, and consumer partners have joined this important conversation about appropriate care. The campaign has reached millions of consumers through an initiative with Consumer Reports – the world’s largest independent product-testing organization – aimed at developing and distributing patient-friendly resources to help spark important conversations between physicians and patients.

To learn more about Choosing Wisely and to view ASH’s ten items to question, visit http://www.ChoosingWisely.org.