Furthermore, systems using PST should be able to perform regular external quality assessment of the testing equipment and patient s ability to obtain accurate INR results. The panel calls upon payers, including the Centers for Medicare and Medicaid Services, to carefully evaluate current reimbursement regulations and make changes as necessary to ensure that unnecessary testing is not incentivized, that providers and patients are aware of this testing option, and that funding is available for those who would like to use PST. The panel identified the following additional research ques- tions. (1) What is the effectiveness of PST compared with DOAC therapy? (2) What is the effectiveness of PST compared with other INR-testing strategies specifically for patients with VTE? Question: For patients receiving maintenance VKA therapy for treatment of VTE, should point-of-care INR testing by the patient at home and self-adjustment of VKA dose (PSM) vs any other management approach be used? For patients receiving maintenance VKA therapy for treatment of VTE we recommend using point-of-care INR testing by the patient at home and self-adjustment of VKA dose (PSM) over any other management approach, including PST, in suitable patients (those with demonstrated competency to perform PSM and who can afford this option) (strong recommendation based on low certainty in the evidence about effects ). Summary of the evidence. Building on the systematic review that addressed PST and PSM,29 we performed a meta- analysis on 16 studies measuring outcomes for patients performing Table 3. 