TY - JOUR
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, T. S.
AU - Nanda, Aman
AU - Agarwal, Bikash
AU - Agnihotri, Parag
AU - Doxsie, G. L.
AU - Gokula, Murthy
AU - Javaheri, Ashkan
AU - Kanagala, M.
AU - Lebelt, Anna S.
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.
N1 - Funding Information:
This study was sponsored by the AMDA Foundation and supported by a grant from Sanofi-Aventis .
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 - VTE prophylaxis
KW - Venous thromboembolism
KW - Venous thromboembolism prophylaxis in LTC
UR - http://www.scopus.com/inward/record.url?scp=84857195342&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84857195342&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2011.04.015
DO - 10.1016/j.jamda.2011.04.015
M3 - Article
C2 - 21621477
AN - SCOPUS:84857195342
SN - 1525-8610
VL - 13
SP - 303
EP - 307
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 3
ER -