Two related studies will evaluate interventions to improve the use of hemostatic blood products. The range and homogeneity of hemostatic blood products have increased over recent years, enhancing their therapeutic effectiveness, and stimulating greater product use. Changes in this area have also been accompanied by a significant frequency of inappropriate or ineffective use, which is costly and wasteful. The studies will provide a basis for action to improve near- and long-term use of hemostatic blood products. A study using the Great Lakes Regional Blood Services will evaluate a series of five interventions designed so they can be implemented by any Regional Center of the American Red Cross. The amount and appropriateness of use of hemostatic blood products in the Great Lakes Region will be measured and the Northern Indiana Regional Center will be a control. A repeated measures analysis of variance will assess the impact of each intervention, and their cumulative impact. The interventions include: a 24-hour telephone consultation service; a program for hospital-based laboratory personnel on lab findings that guide product use; an educational program for patients with congenital bleeding disorders and the general public; educational programs for physicians most likely to encounter bleeding problems; and a program stimulating revision of hospital procedures related to product use. Measures will be made of the specific impact of interventions---use of consultation services, learning outcomes, changes in hospital routines, etc.---and these will be correlated with changes in product use. A second study will use the College of Human Medicine of Michigan State University to evaluate a model program for medical education in hemorrhagic disorders. This model program will be based on an authoritative syllabus designed to be easily adapted to other U.S. medical schools. The model's educational experiences include: a basic expository sequence, a ladder of research experiences, clinical experience embedded in required clerkships, a week-long experience in a hematology rotation, and a specialized 2- or 4-week rotation in hemostatic disorders. Evaluation of each experience will entail measurements of comprehension, skill and judgment in practice, and attitudes related to hemorrhagic problems. These two studies will lead to more efficient and effective use of hemostatic blood products in Michigan. More important, they will provide a critical test of models intervention and education designed for easy replication across the nation.
