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A big problem
Worldwide, 1 in 4 people are anemic, according to the World Health Organization.[1] That means that their blood has a low level of red blood cells or hemoglobin.

Symptoms of anemia include:

• Fatigue, which can be debilitating
• Weakness
• Pale or clammy skin
• Fast heartbeat
• Shortness of breath
• Dizziness or light-headedness

In the United States, an estimated 5.6 percent of the population – more than 18 million people – has anemia, a percentage that has grown significantly over the last 10 years.[2] Among surgical patients, the percentage of people with anemia is much higher – averaging at least 30 percent in the US.[3]

In addition to the impact these symptoms have on quality of life, anemia is also a risk factor for a variety of poor outcomes in surgical patients[4] as anemic patients almost always require a blood transfusion during surgery. Every one of these transfusions adds, on average, one day to a patient’s length of stay, raising the risk of getting a hospital-acquired infection (HAI), a leading cause of patient harm.

Unfortunately, anemia is often both overlooked and undertreated in most surgical patients.

“And herein lies the beginning of the problem,” according to Dr. Frey. “Even mild anemia in surgical patients, especially those with comorbid diseases, can lead to adverse outcomes and may even be life-threatening,” she said.

Reduce blood transfusion overuse

Blood transfusions are the most commonly performed and most overused procedure in U.S. hospitals. Anemic patients almost always cost hospitals more than their bundled insurance payment will cover. These patients are also more likely to need blood transfusions. Reducing the overuse of blood transfusion results in healthier patients and a healthier bottom line.

A simple solution
There is good news though: anemia is modifiable. Said simply, it is possible to treat a patient’s anemia using simple, readily available medications and supplements. A couple of straightforward lab tests can quickly identify whether a patient preparing for surgery has anemia. For patients having elective (non-emergency) surgeries, evaluating them for anemia – and treating it, when appropriate – can also translate to dramatically better patient outcomes, and significantly lower costs.

Barriers to implementation
If anemia is such a risk factor, and is easy to identify and treat, why isn’t every hospital already incorporating anemia management into their standard of care? It’s certainly not because they’re indifferent. Rather, there are process challenges that make it a difficult problem to solve.

Among the biggest barriers are:

1) Lack of visibility.

In order to treat anemic patients, you first need to identify the patients who should be assessed. That is difficult to do across many service areas in a hospital or health system.

2) It’s time sensitive.

It takes time to treat anemic patients before surgery. Ideally, you need several weeks to bring hematocrit and hemoglobin levels up. Catching patients this far in advance is tricky.

3) There are many stakeholders.

The responsibility for anemia management crosses many disciplines, several of which may not coordinate effectively. They include the patient, the primary care provider, the surgeon, and many others – all of whom must be on the same page.

4) Misconceptions surround anemia treatment.

Some doctors may not understand how to treat anemia optimally. Among the misunderstandings that result in suboptimal treatment are:

• The incorrect belief that oral iron is good enough to treat anemia before surgery
• The misconception that IV iron is bad for patients
• The notion that the surgery will fix all the patient’s problems, including anemia

A new paradigm
Clearly, a new approach is needed and there are emerging options available to provide a solution. The solution needs to address the critical questions facing anemia detection and treatment:

• Is the patient scheduled for an elective, high-blood-loss surgery?

Examples include:

• Total joint replacement – knees and hips
• Invasive heart surgery
• Colorectal surgery
• Gynecologic surgery
• Kidney surgery
• Is the time to surgery longer than 14 days?
• Is the patient taking oral iron or vitamin C supplements?
• What are the results of certain anemia-related lab tests, including hemoglobin, hematocrit, iron study, white blood cells, and platelets?
• What are the results of certain renal studies?
• Is there a comorbid state? What comorbidities are there?
• How likely is it that this patient will need a transfusion?

Data collection and sharing are key
There is an Anemia Management software resource that helps address all those questions, MyBloodHealth®.  It pulls all the indicators together with all the other medical content associated with caring for that patient and communicates that information to each stakeholder electronically, offering a summarized calculation of the patient’s risk of transfusion-related adverse events.

The patient’s unique set of data results in the identification of potential perioperative pathways – and more than 800 are available in MyBloodHealth®. Providers can utilize this to build a care plan based on the patient’s specific needs, including a thorough follow-up regimen. MyBloodHealth® in turn gives providers the tools and information they need to incorporate robust anemia management into the patient’s treatment, resulting in better surgical outcomes for the patient, at lower cost for the hospital or health system.

Clinically proven solution
There are several clinically proven benefits to employing an Anemia Management solution such as MyBloodHealth®.  They include:

• Fewer blood transfusions
• Fewer surgical complications
• Shorter length of stay
• Lower incidence of hospital-acquired infections
• Reduced readmission rates
• Quicker recovery
• Increased revenue stream for anemia treatment
• Lower total cost of care

MyBloodHealth®’s efficacy on 2,500 elective, high-blood-loss surgical patients and published and presented their results.[5] Here’s what they found:

• 8 percent of patients were anemic
• Blood transfusion need was reduced by almost 80 percent, as compared to the control group
• 100 percent of blood was used appropriately, with no unnecessary transfusions
• The program saved $1.1M for the hospital

Their study concluded that, “perioperative anemia management, as an outsourced, virtual care management program, may be provided safely, efficiently, and cost effectively in a multihospital system,” stated Dr. Frey.

“This solution is an efficient and effective way to reduce burden of anemia, with the potential to have a dramatic impact on chronic care management and population health management, as well as perioperative management,” said Carney.

Click here to learn more about the MyBloodHealth® software resource as well as a comprehensive Anemia Management solution.

[1] Munoz W, et al. ‘Fit to Fly’ BrJ Anaesth 2015:115:15-24.

[2] Chi Huu Hong Le. “The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012).” PLoS One. November 15, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112924/

[3] Munoz, Manuel. “Pre-operative anaemia: prevalence, consequences and approaches to management.” Blood Transfus. June 16, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614288/; Shander A, Javidroozi M. The patient with anemia. Curr Opin Anesthesiol 2016;29:438-35.

[4] Koch CG, Li L Sun Z, et al. From bad to worse: Anemia on admission and hospital acquired anemia. J Patient Saf 2017; 13:211-16.

[5] “Peri-Operative Patient Specific Blood and Anemia Management in Elective Total Joint Replacement Patients.” http://www.ptready.com/ready/wp-content/uploads/2015/04/AAOS-Poster-Presentation-Frey-MD.pdf

A simple solution

But there is good news: anemia is modifiable. It’s possible to treat a patient’s anemia using simple, readily available medications and supplements. A couple of straightforward lab tests can identify whether a patient preparing for surgery has anemia. For patients having elective (non-emergency) surgeries, evaluating them for anemia – and treating it, when appropriate – can translate to dramatically better patient outcomes, and significantly lower costs.

Barriers to implementation

Since anemia is such a risk factor, and it is easy to identify and treat, why isn’t every hospital already incorporating anemia management into their standard of care? It’s certainly not because they’re indifferent. Rather, there are process challenges that make it a difficult problem to solve. Among the biggest barriers are:

1) There is a lack of visibility – In order to treat anemic patients, you first need to identify the patients who should be assessed. That is difficult to do across many service lines in a hospital or health system.

2) It’s time sensitive – It takes time to treat anemic patients before surgery. Ideally, you need several weeks to bring hematocrit and hemoglobin levels up. Catching patients this far in advance is tricky.

3) There are many stakeholders – The responsibility for anemia management crosses many disciplines who may not coordinate effectively. They include the patient, the primary care provider, the surgeon, and many others, all of whom must be on the same page.

4) Many misconceptions surround anemia treatment – some doctors may not understand how to treat anemia optimally. Among the misunderstandings that result in suboptimal treatment are:

• The incorrect belief that oral iron is good enough to treat anemia before surgery
• The misconception that IV iron is bad for patients
• The notion that the surgery will fix all the patient’s problems, including anemia

A new paradigm

Clearly, a new approach is needed. Accumen’s Anemia Management offers the only virtual perioperative surgical home (VPOSH®) — this software-as-a-service contains a virtual “waiting room” that identifies surgical patients at risk of anemia and synthesizes data that can be used to develop a personalized treatment plan to treat their anemia, if appropriate.

VPOSH™ harnesses the power of a scalable, patented technology that analyzes labs, medical history, and other critical data – and feeds that data into the virtual waiting room. Examples of key factors we analyze are:

• Is the patient scheduled for an elective, high-blood-loss surgery? Examples include:
• Total joint replacement – knees and hips
• Invasive heart surgery
• Colorectal surgery
• Gynecologic surgery
• Kidney surgery
• Is the time to surgery longer than 14 days?
• Is the patient taking oral iron or vitamin C supplements?
• What are the results of certain anemia-related lab tests, including hemoglobin, hematocrit, iron study, white blood cells, and platelets?
• What are the results of certain renal studies?
• Is there a comorbid state? What comorbidities are there?
• How likely is it that this patient will need a transfusion?

Putting everyone in the loop

The system pulls all of those indicators together with all of the other medical content associated with caring for that patient and communicates that information to all stakeholders electronically. The system calculates the patient’s risk of transfusion-related adverse events as well.

The patient’s unique set of data will result in the identification of potential perioperative pathways –more than 800 are available in MyBloodHealth®. Providers can utilize this to select an individualized care plan based on the patient’s specific needs – with a thorough follow-up regimen. This plan, which can be further customized as needed, gives providers the tools and information they need to incorporate robust anemia management into the patient’s treatment, resulting in better surgical outcomes for the patient, at lower cost for the hospital or health system.

Benefits of Accumen’s Anemia Management solution include:

• Fewer blood transfusions
• Fewer surgical complications
• Shorter length of stay
• Lower incidence of hospital-acquired infections
• Reduced readmission rates
• Quicker recovery
• Increased revenue stream for anemia treatment
• Lower total cost of care

Clinically proven effective

The Anemia Management team studied their solution’s efficacy on 2,500 elective, high-blood-loss surgical patients and published and presented their results.[5] Here’s what they found:

• 8 percent of patients were anemic
• Blood transfusion need was reduced by almost 80 percent, as compared to the control group
• 100 percent of blood was used appropriately, with no unnecessary transfusions
• The program saved $1.1M for the hospital

Their study concluded that, “perioperative anemia management, as an outsourced, virtual care management program, may be provided safely, efficiently, and cost effectively in a multihospital system.”

“This solution is an efficient and effective way to reduce burden of anemia, with the potential to have a dramatic impact on chronic care management and population health management, as well as perioperative management,” said Carney.

Click here to learn more about this Anemia Management solution and MyBloodHealth®.

[1] Munoz W, et al. ‘Fit to Fly’ BrJ Anaesth 2015:115:15-24.

[2] Chi Huu Hong Le. “The Prevalence of Anemia and Moderate-Severe Anemia in the US Population (NHANES 2003-2012).” PLoS One. November 15, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112924/

[3] Munoz, Manuel. “Pre-operative anaemia: prevalence, consequences and approaches to management.” Blood Transfus. June 16, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614288/; Shander A, Javidroozi M. The patient with anemia. Curr Opin Anesthesiol 2016;29:438-35.

[4] Koch CG, Li L Sun Z, et al. From bad to worse: Anemia on admission and hospital acquired anemia. J Patient Saf 2017; 13:211-16.

[5] “Peri-Operative Patient Specific Blood and Anemia Management in Elective Total Joint Replacement Patients.” http://www.ptready.com/ready/wp-content/uploads/2015/04/AAOS-Poster-Presentation-Frey-MD.pdf