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Now That’s “Quality”

December 12, 2022

“Quality Improvement”: the opportunity to improve patient care and outcomes through safety, efficiency, effectiveness, and cost containment via systematic frameworks. It is certainly an idea we can all get behind, - but where do we start?

In 2006, the New England Journal of Medicine published a groundbreaking report on “The Quality of Health Care Delivered to Adults in the United States,” reporting that only half of all recommended care processes were provided to adult patients. This and numerous other reports were a call to action for the health care field, creating a movement across specialties to improve the quality of care we provide. Hematologists joined this movement in force, with ASH leading efforts to improve quality for hematology patients ever since. In its broad steps toward quality improvement, ASH has built educational programs on quality improvement, toolkits to assist guideline implementation, and has worked closely with the Choosing Wisely® campaign, among other projects. ASH has also led an effort to create standardized guidelines for select diseases and patient populations, integrating current evidence, standard practice, and expert opinion, which are incorporated into clinical care across the world. 

Each year the Special Symposium on Quality at the annual meeting is an opportunity to learn about these efforts dedicated to improving the quality of care we provide our patients. This year’s Special Symposium of Quality, Quality Improvement Education and Training, which took place Saturday, December 10, focused on improving implementation of  evidence-based guidelines in our practice. Chaired by Dr. Michael Keng, this session included three speakers from different areas of hematology, discussing how they have successfully integrated these models into their practice.

The session began with Dr. Jose Azar, founding member of the Indiana University Center for Healthcare Innovation and Implementation Science and medical director of Quality Improvement and Patient Safety. Dr. Azar discussed the models used in quality improvement science and the impact of human behavior on quality improvement in his session “Realizing the Hippocratic Oath With Quality Improvement.” In this insightful presentation, he used historical references as a framework to describe how human biases, behavior, and notions impact the implementation of improved care models. To address the human element of quality improvement, he discussed the use of improved process improvement models that incorporates behavioral theories to guide the implementation of evidence-based health care services, to both integrate and overcome the biases and behavior of the people involved in these improvement projects.

Following Dr. Azar’s talk, Dr. Ashley Rosko took the stage to discuss how she has successfully incorporated quality improvement models to optimize evidence-based care for older adults in “Quality Improvement Project, Implementing Age-Friendly Practices in Older Adults With Hematologic Malignancies.” Due to the high rates of older adults diagnosed with hematologic malignancies, addressing the complex needs of cancer and aging is a growing challenge for our health care system to meet. Dr. Rosko is a nationally recognized leader in this area as the founder of the ASH Scientific Workshop on Hematology and Aging, a member of the NCCN Older Adult Oncology panel, as well as a multiple myeloma specialist and medical director of the Ohio State University oncogeriatric program. She also co-directs the Cancer and Aging Resiliency Clinic at The James — a multidisciplinary care clinic for aging adults with cancer and one of the first of its kind. This clinic was built from her efforts to incorporate geriatric assessments in routine oncologic practice. This was a multiyear effort that required a large multidisciplinary team, but which has now successfully provided outstanding oncogeriatric care to thousands of patients. In Sunday’s session she discussed how her project has developed and changed over time through developing practice consensus and rebranding efforts, and continually expanding.

Finishing the session with a discussion of quality improvement for our pediatric population was Dr. Rachael Grace, Director of Hematology Clinical Research at Harvard Medical School, Boston Children’s Hospital. In her talk “Quality Improvement Project, Immune Thrombocytopenia,” she described her efforts to improve the implementation of ASH and Choosing Wisely® guidelines to avoid unnecessary interventions in asymptomatic pediatric ITP patients. She reviewed how she developed this project from a retrospective review that found troubling rates of treatment in patients without active bleeding (only 40% were in line with current guidelines), and how her efforts to decrease practice variation, which required multiple project iterations, resulted in an improvement to 63 percent compliance. Additionally, she discussed how to expand a successful quality improvement project to multiple sites and how she incorporates trainees in this process.

This session was a powerful call to action from inspirational leaders in the field. These three speakers discussed effective ways to incorporate guideline-directed care and quality improvement methods into our practice in order to provide better care for our patients. If you were looking for a “quality” session to invigorate and inspire you for your return to patient care, this is it.

Dr. Vardell and Dr. Mohyuddin indicated no relevant conflicts of interest.

Photo 1: Dr. Jose Azar during Saturday’s Special Symposium on Quality.

Photo 2: Dr. Ashley Rosko during Saturday’s Special Symposium on Quality.


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