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Special Symposium on Quality: When Less Is Not More

December 11, 2023
Megan Sears-Smith, DO, and Brittany Knick Ragon, MD, (@BKRagonMD)
Atrium Health Levine Cancer Institute, Charlotte, NC

The Special Symposium on Quality featured three major areas of improvement for increased utilization of vital resources for patients: inferior vena cava (IVC) filter removal, hydroxyurea in sickle cell disease, and patient education prior to anticoagulation. Ming Y. Lim, MBBCh, one of the co-chairs for the Special Symposium Committee told us, “The most exciting aspect of the topics being presented are the successful interventions and programs from each presenter that have effectively addressed underuse in their specific topic with a focus on collaboration among healthcare professionals, policymakers and patient advocacy groups.” 

IVC filter retrieval remains an important topic in hematology, due to the risk an unnecessary filter left in place can pose to an unsuspecting patient.  Symposium speaker Geoffrey D. Barnes, MD, from the University of Michigan, feels very strongly about increasing retrieval rates of IVC filters in hematology patients. “Every week in clinic, I see patients who had IVC filters placed for indications we now know are not appropriate,” he shared in advance of his presentation on Saturday. “But what is more concerning is how many of them have debilitating thrombotic complications, often with entire IVC thromboses that require multiple procedures to manage.” 

During his presentation, he discussed multicomponent interventions to improve retrieval rates at institutions, including email reminders to the physician that placed the filter and having a dedicated physician champion for this effort, and the success this has had at multiple institutions.  “Anything we can do to reduce the use of IVC filters and to get them removed as quickly as possible will help to reduce the devastating burden that a thrombosed IVC can have on a patient’s quality of life,” he urged. 

It is now well known in hematology that hydroxyurea is one of the most studied disease-modifying therapies for sickle cell disease and is often the first-line treatment for these patients. However, within the general community, initiation and titration of hydroxyurea is not always accomplished for multiple reasons.  Alexandra Power-Hays, MD, from the University of Cincinnati College of Medicine, educated us about the importance of initiation of hydroxyurea as well as appropriate titration to improve both morbidity and mortality in our patients with sickle cell disease. “It's incredible that gene therapy is so close on the horizon, but the safest, most widely available, most effective, best studied medical treatment is still sorely underutilized,” she said. She also offered ideas and evidence-based approaches to provider-based biases and stigma related to patients with SCD in general, as well as underuse due to unfamiliarity or unfounded concerns about the medication, such as concerns about malignancy risk or infertility. “I'm passionate about improving care for people with sickle cell disease and addressing barriers to accessing evidence-based care, in the United States and internationally,” said Dr. Power-Hays.  

Finally, Allison E. Burnett, PharmD, from the University of New Mexico Health Sciences Center, spoke about patient education prior to starting anticoagulation.  Informing patients with cancer about their risk for thrombosis and the potential role for prophylactic anticoagulation (AC) is one of the first steps physicians can take when empowering patients about their health. She also discussed interventions regarding better communication and shared decision making when discussing AC with patients to increase their understanding and find a suitable medication for their needs. “The most effective anticoagulant is the one the patient is going to take,” Dr. Burnett said. She closed with additional information about ways providers can improve patient education about (AC), including increasing personal knowledge, contributions to development of educational tools/methods, and even becoming a provider champion for improvement of system-level AC education.  

In summary, when asked what central message the attendees can take away from this impressive lecture, Dr. Lim replied, “I hope the sessions raise awareness about the underutilization of hematologic care services and ... provide strategies and insights on how to identify and address this issue.” 

As we all know, quality hematologic care is invaluable to the overall health of our patients. Addressing underuse in these three key areas is one big step toward improving patient wellbeing and enhancing pride that we as hematologists take in our work. And while we’ve all at some point invoked the adage “less is more,” it’s important to realize that other times, well, simply put more is more and perhaps even necessary. 

Drs. Sears-Smith and Ragon indicated no relevant conflicts of interest. 



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