Venous thromboembolism (VTE), which comprises both deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common preventable cause of hospital death. Veterans with cancer, and particularly those who undergo surgery are at particularly high risk with up to one-third of untreated patients (no
prophylaxis) developing deep venous thrombosis. Guidelines from the American College of Chest Physicians recommend prophylaxis throughout the hospital course and continuing post discharge for 4 weeks after surgery. Current hospital process measures (VA Surgical Quality Improvement Program-VASQIP VTE
measure, Joint Commission's Surgical Care Improvement Project SCIP-VTE-2) only examine prophylaxis during the procedure or in the 24 hours around the time of surgery rendering them inadequate in evaluating and promoting performance. Collaborative training modules from the Illinois Surgical Quality Improvement Collaborative (ISQIC) are available to raise awareness of VTE risk and prevention strategies among surgeons, surgical care teams, nurses and patients. We propose a VISN 12 directed evaluation to determine the effect of
VTE risk education modules on both inpatient and outpatient VTE prophylaxis.
We propose the following Specific Aims:
Aim 1: To determine whether multi-modal, provider-focused educational interventions can improve receipt of VTE inpatient chemoprophylaxis and ordering of post-discharge chemoprophylaxis after major cancer surgery
in four VISN 12 hospitals.
H1: Scalable interventions for postoperative VTE prophylaxis can be effective in addressing local care barriers to receipt of inpatient chemoprophylaxis and ordering of post-discharge chemoprophylaxis.
Aim 2: To identify patient and nursing provider perceptions of barriers to guideline-concordant care during the transition from inpatient to outpatient postsurgical VTE prophylaxis.
H1: Inpatient and post-discharge prophylaxis adherence is variable for Veterans after major cancer surgery due to lack of VTE risk awareness.
Aim 3: To perform a cost identification and budget impact analysis of increasing adherence to VTE prophylaxis guidelines.
Aim 1 methods will determine if provider-focused educational interventions can improve receipt of VTE inpatient chemoprophylaxis and ordering of post-discharge chemoprophylaxis after major cancer surgery in VISN 12 hospitals.
The interventions will include the ISQIC VTE Bundle elements: Caprini risk assessment tools, audit/feedback of provider prescribing habits, risk awareness education for nurses and patients. Pre & Post intervention rate of missed doses of inpatient chemoprophylaxis and ordering of post-discharge chemoprophylaxis for high risk surgical patients will be measured.
Aim 2 will use a mixed methods approach to determine factors associated with nurse and patient adherence to VTE prophylaxis guidelines.
Aim 3 will determine the budget impact of improved compliance with VTE chemoprophylaxis after a provider-focused behavioral intervention. All costs will be summarized and confidence intervals calculated.
None to date.
This study will provide evidence on implementation of provider VTE risk education in a collaborative setting to encourage appropriate use of chemoprophylaxis.
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