Prevention of Venous Thromboembolism in Long Term Care: Results of a Multicenter Educational Intervention Using Clinical Practice Guidelines: Part 2 of 2 (an AMDA Foundation Project)

Thiruvinvamalai S. Dharmarajan, Aman Nanda, Bikash Agarwal, Parag Agnihotri, G. L. Doxsie, Murthy Gokula, Ashkan Javaheri, Madhusudhana R. Kanagala, Anna Skokowska-Lebelt, Prasuna Madireddy, Sourya Mahapatra, P. Murakonda, S. Ram Rao Muthavarapu, Mennakshi Patel, Christopher Patterson, Kathleen Soch, Anna Troncales, Kamal Yaokim, Robin Kroft, Edward P. Norkus

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: Implementation of prophylaxis for venous thomboembolism (VTE) through risk assessment based on clinical practice guidelines (CPGs) is variably adopted in long term care facilities (LTCF). Current guidelines recommend venous thromboembolism prophylaxis (VTE-P) following risk assessment, individualized to patient status. In LTCF, differing comorbidity, life-expectancy, ethical, and quality-of-life issues may warrant a unique approach. This article examines VTE-P practices in LTCF before and after educational intervention to bring practice patterns consistent with CPGs. Methods: Phase 1 (preceding article in this issue) identified current practice to assess risk and implement VTE-P (17 geographically diverse LTCFs, 3260 total beds). Phase 2 (educational intervention using CPGs) and Phase 3 (outcomes) reexamined VTE-P at the same 17 centers. Results: The frequency of indications for VTE-P and contraindications to anticoagulation were similar during Phases 1 and 3 (all P >.05). In Phase 3, use of aspirin alone decreased more than 50% (P <.0005), whereas use of compression devices increased (P <.0005). Regression models predicted no relationship between any indication or contraindication and VTE-P in Phase 1 (all P >.05) but identified significant relationships between indication and contraindications and VTE-P in Phase 3 (P=.022 to P <.0005), suggesting adequate understanding of current CPGs following education as the basis for improved VTE-P. Conclusions: The study confirms the presence of significant comorbidity in LTC residents, many with indications for VTE-P, some with contraindications for anticoagulation. Following educational intervention, more residents received VTE-P, influenced by risk-benefit ratio favoring treatment. These findings suggest that even a modest educational intervention significantly improves provider knowledge pertinent to risk assessment consistent with CPG and more appropriate VTE-P.

Original languageEnglish (US)
Pages (from-to)303-307
Number of pages5
JournalJournal of the American Medical Directors Association
Volume13
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Venous Thromboembolism
Long-Term Care
Practice Guidelines
Comorbidity
Quality of Life
Life Expectancy
Aspirin
Odds Ratio
Guidelines
Education

Keywords

  • DVT
  • Mechanical measures to prevent VTE
  • Pulmonary embolism
  • Venous thromboembolism
  • Venous thromboembolism prophylaxis in LTC
  • VTE prophylaxis

ASJC Scopus subject areas

  • Medicine(all)
  • Nursing(all)
  • Health Policy

Cite this

Prevention of Venous Thromboembolism in Long Term Care : Results of a Multicenter Educational Intervention Using Clinical Practice Guidelines: Part 2 of 2 (an AMDA Foundation Project). / Dharmarajan, Thiruvinvamalai S.; Nanda, Aman; Agarwal, Bikash; Agnihotri, Parag; Doxsie, G. L.; Gokula, Murthy; Javaheri, Ashkan; Kanagala, Madhusudhana R.; Skokowska-Lebelt, Anna; Madireddy, Prasuna; Mahapatra, Sourya; Murakonda, P.; Rao Muthavarapu, S. Ram; Patel, Mennakshi; Patterson, Christopher; Soch, Kathleen; Troncales, Anna; Yaokim, Kamal; Kroft, Robin; Norkus, Edward P.

In: Journal of the American Medical Directors Association, Vol. 13, No. 3, 03.2012, p. 303-307.

Research output: Contribution to journalArticle

Dharmarajan, TS, Nanda, A, Agarwal, B, Agnihotri, P, Doxsie, GL, Gokula, M, Javaheri, A, Kanagala, MR, Skokowska-Lebelt, A, Madireddy, P, Mahapatra, S, Murakonda, P, Rao Muthavarapu, SR, Patel, M, Patterson, C, Soch, K, Troncales, A, Yaokim, K, Kroft, R & Norkus, EP 2012, 'Prevention of Venous Thromboembolism in Long Term Care: Results of a Multicenter Educational Intervention Using Clinical Practice Guidelines: Part 2 of 2 (an AMDA Foundation Project)', Journal of the American Medical Directors Association, vol. 13, no. 3, pp. 303-307. https://doi.org/10.1016/j.jamda.2011.04.015
Dharmarajan, Thiruvinvamalai S. ; Nanda, Aman ; Agarwal, Bikash ; Agnihotri, Parag ; Doxsie, G. L. ; Gokula, Murthy ; Javaheri, Ashkan ; Kanagala, Madhusudhana R. ; Skokowska-Lebelt, Anna ; Madireddy, Prasuna ; Mahapatra, Sourya ; Murakonda, P. ; Rao Muthavarapu, S. Ram ; Patel, Mennakshi ; Patterson, Christopher ; Soch, Kathleen ; Troncales, Anna ; Yaokim, Kamal ; Kroft, Robin ; Norkus, Edward P. / Prevention of Venous Thromboembolism in Long Term Care : Results of a Multicenter Educational Intervention Using Clinical Practice Guidelines: Part 2 of 2 (an AMDA Foundation Project). In: Journal of the American Medical Directors Association. 2012 ; Vol. 13, No. 3. pp. 303-307.
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abstract = "Introduction: Implementation of prophylaxis for venous thomboembolism (VTE) through risk assessment based on clinical practice guidelines (CPGs) is variably adopted in long term care facilities (LTCF). Current guidelines recommend venous thromboembolism prophylaxis (VTE-P) following risk assessment, individualized to patient status. In LTCF, differing comorbidity, life-expectancy, ethical, and quality-of-life issues may warrant a unique approach. This article examines VTE-P practices in LTCF before and after educational intervention to bring practice patterns consistent with CPGs. Methods: Phase 1 (preceding article in this issue) identified current practice to assess risk and implement VTE-P (17 geographically diverse LTCFs, 3260 total beds). Phase 2 (educational intervention using CPGs) and Phase 3 (outcomes) reexamined VTE-P at the same 17 centers. Results: The frequency of indications for VTE-P and contraindications to anticoagulation were similar during Phases 1 and 3 (all P >.05). In Phase 3, use of aspirin alone decreased more than 50{\%} (P <.0005), whereas use of compression devices increased (P <.0005). Regression models predicted no relationship between any indication or contraindication and VTE-P in Phase 1 (all P >.05) but identified significant relationships between indication and contraindications and VTE-P in Phase 3 (P=.022 to P <.0005), suggesting adequate understanding of current CPGs following education as the basis for improved VTE-P. Conclusions: The study confirms the presence of significant comorbidity in LTC residents, many with indications for VTE-P, some with contraindications for anticoagulation. Following educational intervention, more residents received VTE-P, influenced by risk-benefit ratio favoring treatment. These findings suggest that even a modest educational intervention significantly improves provider knowledge pertinent to risk assessment consistent with CPG and more appropriate VTE-P.",
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T1 - Prevention of Venous Thromboembolism in Long Term Care

T2 - Results of a Multicenter Educational Intervention Using Clinical Practice Guidelines: Part 2 of 2 (an AMDA Foundation Project)

AU - Dharmarajan, Thiruvinvamalai S.

AU - Nanda, Aman

AU - Agarwal, Bikash

AU - Agnihotri, Parag

AU - Doxsie, G. L.

AU - Gokula, Murthy

AU - Javaheri, Ashkan

AU - Kanagala, Madhusudhana R.

AU - Skokowska-Lebelt, Anna

AU - Madireddy, Prasuna

AU - Mahapatra, Sourya

AU - Murakonda, P.

AU - Rao Muthavarapu, S. Ram

AU - Patel, Mennakshi

AU - Patterson, Christopher

AU - Soch, Kathleen

AU - Troncales, Anna

AU - Yaokim, Kamal

AU - Kroft, Robin

AU - Norkus, Edward P.

PY - 2012/3

Y1 - 2012/3

N2 - Introduction: Implementation of prophylaxis for venous thomboembolism (VTE) through risk assessment based on clinical practice guidelines (CPGs) is variably adopted in long term care facilities (LTCF). Current guidelines recommend venous thromboembolism prophylaxis (VTE-P) following risk assessment, individualized to patient status. In LTCF, differing comorbidity, life-expectancy, ethical, and quality-of-life issues may warrant a unique approach. This article examines VTE-P practices in LTCF before and after educational intervention to bring practice patterns consistent with CPGs. Methods: Phase 1 (preceding article in this issue) identified current practice to assess risk and implement VTE-P (17 geographically diverse LTCFs, 3260 total beds). Phase 2 (educational intervention using CPGs) and Phase 3 (outcomes) reexamined VTE-P at the same 17 centers. Results: The frequency of indications for VTE-P and contraindications to anticoagulation were similar during Phases 1 and 3 (all P >.05). In Phase 3, use of aspirin alone decreased more than 50% (P <.0005), whereas use of compression devices increased (P <.0005). Regression models predicted no relationship between any indication or contraindication and VTE-P in Phase 1 (all P >.05) but identified significant relationships between indication and contraindications and VTE-P in Phase 3 (P=.022 to P <.0005), suggesting adequate understanding of current CPGs following education as the basis for improved VTE-P. Conclusions: The study confirms the presence of significant comorbidity in LTC residents, many with indications for VTE-P, some with contraindications for anticoagulation. Following educational intervention, more residents received VTE-P, influenced by risk-benefit ratio favoring treatment. These findings suggest that even a modest educational intervention significantly improves provider knowledge pertinent to risk assessment consistent with CPG and more appropriate VTE-P.

AB - Introduction: Implementation of prophylaxis for venous thomboembolism (VTE) through risk assessment based on clinical practice guidelines (CPGs) is variably adopted in long term care facilities (LTCF). Current guidelines recommend venous thromboembolism prophylaxis (VTE-P) following risk assessment, individualized to patient status. In LTCF, differing comorbidity, life-expectancy, ethical, and quality-of-life issues may warrant a unique approach. This article examines VTE-P practices in LTCF before and after educational intervention to bring practice patterns consistent with CPGs. Methods: Phase 1 (preceding article in this issue) identified current practice to assess risk and implement VTE-P (17 geographically diverse LTCFs, 3260 total beds). Phase 2 (educational intervention using CPGs) and Phase 3 (outcomes) reexamined VTE-P at the same 17 centers. Results: The frequency of indications for VTE-P and contraindications to anticoagulation were similar during Phases 1 and 3 (all P >.05). In Phase 3, use of aspirin alone decreased more than 50% (P <.0005), whereas use of compression devices increased (P <.0005). Regression models predicted no relationship between any indication or contraindication and VTE-P in Phase 1 (all P >.05) but identified significant relationships between indication and contraindications and VTE-P in Phase 3 (P=.022 to P <.0005), suggesting adequate understanding of current CPGs following education as the basis for improved VTE-P. Conclusions: The study confirms the presence of significant comorbidity in LTC residents, many with indications for VTE-P, some with contraindications for anticoagulation. Following educational intervention, more residents received VTE-P, influenced by risk-benefit ratio favoring treatment. These findings suggest that even a modest educational intervention significantly improves provider knowledge pertinent to risk assessment consistent with CPG and more appropriate VTE-P.

KW - DVT

KW - Mechanical measures to prevent VTE

KW - Pulmonary embolism

KW - Venous thromboembolism

KW - Venous thromboembolism prophylaxis in LTC

KW - VTE prophylaxis

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