Identifying and addressing underuse in hematologic care through systems-based hematology

Jacob C Cogan; Allison E Burnett; Alexandra Power-Hays; Geoffrey D Barnes; Ming Y Lim

doi:10.1016/j.rpth.2025.102881

Identifying and addressing underuse in hematologic care through systems-based hematology

Res Pract Thromb Haemost. 2025 May 8;9(4):102881. doi: 10.1016/j.rpth.2025.102881. eCollection 2025 May.

Authors

Jacob C Cogan¹, Allison E Burnett², Alexandra Power-Hays^{3

4}, Geoffrey D Barnes⁵, Ming Y Lim⁶

Affiliations

¹ Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA.
² College of Pharmacy, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
³ Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁴ Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
⁵ Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.

Abstract

Underuse of high-value hematologic care receives comparatively less attention than the overuse of unnecessary tests and treatments. In this review, we analyze examples of underutilized care in several domains: procedural (inferior vena cava filter retrieval), medical (hydroxyurea use in sickle cell anemia), and patient-facing (education prior to anticoagulation). For each, we justify the need for increased uptake and highlight examples of systems-based hematology interventions to accomplish this. While reducing overused care is appealing from a cost savings perspective, we advocate for equal attention and investment toward promoting underused care.

Keywords: IVC filter; anticoagulation; hydroxyurea; sickle cell anemia; underuse.

Publication types

Review