Improving the quality of care delivered to patients with hematologic diseases is the most important mandate for clinicians practicing in our specialty. The need for quality improvement in health care has been detailed in reports from the Institute of Medicine and oft-cited articles, such as that by Elizabeth A. McGlynn, PhD, and colleagues whose research concluded that 50 percent of recommended care is not being delivered.1 ASH has responded to these serious concerns by providing leadership in developing an array of quality-improvement efforts.
We have created guidelines for selected diseases, distilled existing guidelines into highly popular pocket guides and mobile applications, and hosted both webinars and sessions at the annual meeting on quality improvement. These efforts have been well and ably executed by the ASH Subcommittee on Quality of Care. I want to take this opportunity to thank Mary Cushman, MD, for her superb leadership of that subcommittee for the past two years.
The landscape in quality improvement is changing constantly as evidenced by 1) new Medicare and private insurance programs that tie professional reimbursement to quality guidelines and measures, and 2) the latest changes to the Maintenance of Certification programs. The most recent quadrennial ASH survey captured the importance of these changes to our membership, with clinical practice guidelines being among the products you most commonly request from the Society. With the initiation of Accountable Care Organizations and other tenets of the Patient Protection and Affordable Care Act (i.e., Obamacare) in January 2014 and onward, defining and measuring quality will have greater significance.
Given these drivers, the ASH Executive Committee charged a task force chaired by Linda Burns, MD, and Adam Cuker, MD, and composed of representatives from many of ASH’s standing committees, to envision a next generation of ASH quality programs to meet member needs and proactively address quality issues in a comprehensive way. The Executive Committee wholeheartedly endorsed the task force’s recommendations to establish an ASH Quality Initiative, components of which include the following:
1. Create additional clinical practice guidelines in hematology at a faster pace. Determine the best methods to integrate standard practice, expert opinion, and other inputs when an evidence-based assessment is not available. These guidelines will be developed with the needs of busy clinicians in mind.
2. Develop “toolkits” to assist hematology practices with implementation of the guidelines. The toolkits will continue to include pocket guides, apps, and webinars as well as practice-improvement modules for certification and quality measures for pay-for-performance reporting.
3. Represent hematologists vigorously in policy discussions about tying reimbursement to quality.
ASH considers these efforts our obligation and responsibility. I encourage you to email ASH at quality@hematology.org with your thoughts about quality-improvement topics and programs that the Society should consider. Member input will be an important resource for the newly formed Committee on Quality, which includes members with both methodologic and disease-based expertise and is chaired by Mark Crowther, MD.
ASH supports an organized, graded approach to the teaching of principles of quality care and clinical competency with measurable outcomes beginning in the first year of fellowship. For an example of an approach to this process, please read the article by Dr. Meir Preis and Dr. Christian Cable, "Developing a Treatment Plan as a Core Competency of Hematology Training," in this edition of The Hematologist.
