Although the panel agreed that a strong recommendation in favor of PSM was warranted based on the available evidence, in settings where resources are limited or when patients are not willing or able to perform PSM, system decision- makers or individual patients may choose against PSM. Furthermore, systems using PSM should be able to perform regular external quality assessment of the testing equipment and patients ability to obtain accurate INR results and make rational VKA dosing decisions using instructions from their health care providers. 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 wish to use PSM. The panel identified the following additional research questions. (1) What is the effectiveness of PSM of VKA compared with DOAC therapy? (2) What is the effectiveness of PSM compared with other INR management strategies, specifically for patients with VTE? (3) What minimum competencies are required to engage in PSM and what is the most effective way to train patients to perform PSM? Selecting the timing between INR measurements (INR recall interval) Question: For patients receiving VKA therapy for treatment of VTE, should a shorter INR recall interval vs a longer INR recall interval be used following VKA dose adjustment due to an out-of-target-range INR? For patients receiving VKA therapy for treatment of VTE, the ASH guideline panel suggests using an INR recall interval of 4 weeks or fewer rather than intervals longer than 4 weeks fol- lowing VKA dose adjustment due to an out-of-target-range INR (conditional recommendation based on very low certainty in the evidence about effects ). Summary of the evidence. 