INNOVATIVE APPROACH TO IMPROVE HEALTHCARE OUTCOMES OF A BLEEDING DISORDER

SÁNCHEZ LUCEROS A; RYDZ N; FAVALORO E; LAVIN M; OTHMAN M; ACHARYA S

Toronto

Congreso; e-Health Conference; 2017

COACH: Canada?s Health Informatics Association, Canada Health Infoway, CIHI ? Canadian Institute for Health Information

Purpose /Objectives: Rare inherited bleeding disorders such as platelet type von Willebrand disease (PT-VWD) exhibit diagnostic challenges and standard guidelines are yet to be available. Lengthy misdiagnoses and subsequently inappropriate treatments can have serious implications on both the patient and the heath care system. Mysteries around the disease exist and research funding is scarce, leaving scientists with limited resources to support such underprivileged patients. The purpose of this study is to propose a new interdisciplinary approach involving the primary care physician, the specialist, and the laboratory to improve diagnosis and management of PT-VWD. Methodology/Approach Extensive international work www.pt-vwd.org on this rare disease with over 10 years of experience (Othman etal., J Thromb Haemost. 2016;14(2):411-4) and established International Society of Thrombosis and Haemostasis guidelines for diagnosis of inherited platelet disorders (Gresele etal., J Thromb Haemost 2015; 13: 314?22) together with a recent case series report (Sánchez-Luceros etal., Platelets 2016; in press) have provided the foundation for this proposal. The required resources including physician awareness/education, appropriate laboratory tests and personnel training were examined. Models from other systems/countries have also been evaluated. The proposal is based on: integration of a specific education module into physicians? (primary care and specialists) CME program and the implementation of a simple diagnostic algorithm where essentially all patients with a provisional diagnosis of type 2B VWD, Immune thrombocytopenic purpura or neonatal alloimmune thrombocytopenia, would undergo simplified RIPA mixing assay (Favaloro Semin Thromb Hemost 2008; 34: 113?27) followed by genetic analysis for confirmation.Findings: A flow chart representing the diagnostic problem, implications of delayed diagnoses and the suggested interdisciplinary approach involving all stakeholders together with the proposed diagnostic algorithm will be presented.Implications/recommendation It is anticipated that incorporating this approach directly into the clinical setting shall improve diagnosis of the disease, reduce health care costs resulting from unnecessary lab testing and inappropriate treatments and most importantly shall minimize patients? serious bleeding complications.