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This site is intended for US Population-Health Decision Makers or similar entities at hospitals and US oncology practices.

MF QI Case Study

Patients with MF may not realize that their symptoms are related to their disease.1However, changes in symptom status can be a sign of disease progression.2

Levine Cancer Institute Case Study

Implementing a Quality Initiative for Patients With MF

The Plan

  • The Levine Cancer Institute of Atrium Health recently completed a 12-month quality improvement initiative as a partnership between leukemia physicians and the Atrium Health specialty pharmacy3
  • The goal was to optimize the existing physician and specialty pharmacy clinical workflow in the assessment of risk category and symptom burden in patients with MF3
5-Step Specialty Pharmacy Service MF Consult Workflow3:

Step 1

MF patient identified and referred for telehealth pharmacist consult

Step 2

MF patient added to pharmacist consult queue

Step 3

10 days prior to next clinic appointment, pharmacist completes MPN-SAF TSS

Step 4

Pharmacist reviews labs/karyotype and completes DIPSS-Plus

Step 5

Assessments uploaded to EMR; patient moved ahead in queue by ~3 months to repeat

The Results

of participating physicians

reported decreased clinic appointment time with the specialty pharmacy’s involvement3



they now incorporate MF symptom assessments into their patient evaluations and that they value the specialty pharmacy’s participation in clinical assessments3
The Quality Initiative implemented by Levine Cancer Institute suggested that a collaboration between physicians and pharmacists is possible, and may be an important component of high-quality, efficient care in patients with MF3
How to Implement a Quality Initiative for Patients with MF


Search your EHR system for patients with MF

- MF, ICD-10 code D75.81


Check if symptom assessments are part of the patient’s EHR and how they were measured


Monitor your EHR system regularly and notify clinicians of patients who have burdensome symptoms


Implement a formal system for symptom assessment if none exists

Establish QI Champions in Your Practice

Collaboration among care team members is key when implementing a QI to help develop and operationalize individualized care plans

Executive leadership & practice administration

May identify quality areas of interest for practice focus and leads future implementation into practice workflows


Leads strategic implementation of Quality Initiatives that deliver on areas of interest for the practice and supports ongoing implementation and care plan adjustments


Consults with pharmacist and incorporates specialty pharmacists’ assessments into the patient’s care plans

DIPSS-Plus=Dynamic International Prognostic Scoring System-Plus; EHR=electronic health record; EMR=electronic medical records; ICD-10=International Statistical Classification of Diseases and Related Health Problems, 10th revision; MF=myelofibrosis; MPN=myeloproliferative neoplasm; MPN-SAF TSS=Myeloproliferative Neoplasm-Symptom Assessment Form Total Symptom Score.

References: 1. Mesa RA, Miller CB, Thyne M, et al. Differences in treatment goals and perception of symptom burden between patients with myeloproliferative neoplasms (MPNs) and hematologists/oncologists in the United States: findings from the MPN Landmark survey. Cancer. 2017;123(3):449-458. doi:10.1002/cncr.30325 2. Emanuel RM, Dueck AC, Geyer HL, et al. Myeloproliferative neoplasm (MPN) symptom assessment form total symptom score: prospective international assessment of an abbreviated symptom burden scoring system among patients with MPNs. J Clin Oncol. 2012;30(33):4098-4103. doi:10.1200/JCO.2012.42.3863 3. Chojecki AL, DiSogra KY, Arnall J, et al. Optimization of physician and specialty pharmacy clinical workflow in assessment of risk category and symptom burden in patients with myelofibrosis (MF). Leuk Lymphoma. 2022;63(6):1515-1517. doi:10.1080/10428194.2022.2032037