A diagnostic hematology clinic pilot program: Increasing access and optimizing resources

Abstract

Abstract Introduction: The demand for specialized care in hematology is high and continues to rise. The complete blood count (CBC) is a widely available laboratory test that frequently reveals incidental abnormalities, prompting a large volume of referrals for specialist evaluation. This referral volume has begun to overwhelm provider capacity, reducing access to hematology and oncology care. Methods: We piloted a hematologist-led, advanced practice provider (APP)-supported Diagnostic Hematology Clinic (DHC) program within the James Cancer Diagnostic Center at The Ohio State University (OSU) Comprehensive Cancer Center. The main objectives included 1) reducing lag time between referral and first appointment and 2) streamlining the diagnostic process to directly triage patients to a hematology sub-specialist when appropriate. Referrals to Hematology for non-severe CBC abnormalities or elevated ferritin were triaged to the DHC. Patients had an initial evaluation with a hematologist or APP and up to three subsequent follow-up visits via telemedicine. APPs received continuous, real-time education on appropriate diagnostic evaluations and interpretation of results. Quality data were collected to assess impact on lag times, destination of triage and patient and referring primary care provider (PCP) satisfaction. Results: Between July 2024 and January 2025, there were 211 new patient visits at the James DHC, of which 52% were conducted by an APP. There were 163 telemedicine follow-up visits, 95% conducted by an APP. Two-thirds of the referrals originated from the within the OSU medical system. The most common referral diagnoses were: thrombocytosis/elevated platelet count (n=36), leukocytosis (unspecified)(n=33), leukopenia (unspecified) (n=19), neutropenia in the context of cancer treatment (n=12), and “abnormal CBC” (n=13). The average lag time from referral to first appointment was 25 days, compared to 75 days for physicians in Classical Hematology. After evaluation at the James DHC, 44% of patients were referred back to their PCP, 28% were referred to a Classical Hematology specialist, 9% to other hematology subspecialists (chronic lymphocytic leukemia n=6, clonal hematopoiesis/myelodysplastic syndrome n=7, lymphomas n=6). Seventeen percent of patients were referred to other specialists (sleep medicine n=7, rheumatology n=5, gastroenterology n=3, hepatology n=3, others n=7). Between July and September'24, patient satisfaction scores based on CG-CAHPS ranged from 66.7 to 87.5; between October ‘24 and Jan ‘25, the score ranged from 87.5 to 100. Eighty nine percent of patient survey responders would recommend the DHC to family and friends. Among referring providers (n=16 of 98 surveys sent), 44% were very satisfied and 31% were satisfied with the overall experience with the DHC. Sixty-nine percent of respondents were ‘satisfied’ or ‘very satisfied’ with the lag time from referral to first appointment, and 8 providers valued most the increased access/timeliness of evaluation provided by the DHC. Over 80% of providers considered that patient assessment and plans were delivered ‘usually’ or ‘always’ within a reasonable timeframe; 69% reported the quality of consultation was ‘excellent’ or ‘good’, and 86% were ‘comfortable’ or ‘very comfortable’ with the plan provided by the DHC when the patients were discharged back to their care. The DHC impacted patient care ‘positively’ or' very positively' according to 88% of referring providers, and 81% of them were ‘likely’ or ‘extremely likely’ to refer patients again to the DHC. Of note, no referring provider specifically expressed concerns that evaluations were conducted by APPs when relevant. Conclusion: Our pilot program of a hematologist-led, APP-supported DHC ultimately resulted in a reduction in lag time between referrals to hematology clinic and initial consultation. Patients requiring triage to other subspecialists received this approximately 50 days sooner. Patient satisfaction improved significantly in the last 3 months of the clinic, perhaps representing patient confidence in the growing skill set of participating APPs or reduced wait times. Referring providers valued most the increased access to specialist's evaluation and were overall satisfied with the service. Opportunities remain to work more effectively with referring providers. Further development of this DHC model may significantly and positively impact healthcare systems and patient care experience.