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)
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 ass...
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| creator | Dharmarajan, T.S., MD Nanda, Aman, MD Agarwal, Bikash, MD Agnihotri, Parag, MD Doxsie, G.L., GNP Gokula, Murthy, MD Javaheri, Ashkan, MD Kanagala, M., MD Lebelt, Anna S., MD Madireddy, Prasuna, MD Mahapatra, Sourya, MD Murakonda, P., MD Rao Muthavarapu, S. Ram, MD Patel, Mennakshi, MD Patterson, Christopher, MD Soch, Kathleen, MD Troncales, Anna, MD Yaokim, Kamal, MD Kroft, Robin, PhD Norkus, Edward P., PhD |
| description | 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. |
| doi_str_mv | 10.1016/j.jamda.2011.04.015 |
| format | Article |
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Ram, MD ; Patel, Mennakshi, MD ; Patterson, Christopher, MD ; Soch, Kathleen, MD ; Troncales, Anna, MD ; Yaokim, Kamal, MD ; Kroft, Robin, PhD ; Norkus, Edward P., PhD</creator><creatorcontrib>Dharmarajan, T.S., MD ; Nanda, Aman, MD ; Agarwal, Bikash, MD ; Agnihotri, Parag, MD ; Doxsie, G.L., GNP ; Gokula, Murthy, MD ; Javaheri, Ashkan, MD ; Kanagala, M., MD ; Lebelt, Anna S., MD ; Madireddy, Prasuna, MD ; Mahapatra, Sourya, MD ; Murakonda, P., MD ; Rao Muthavarapu, S. Ram, MD ; Patel, Mennakshi, MD ; Patterson, Christopher, MD ; Soch, Kathleen, MD ; Troncales, Anna, MD ; Yaokim, Kamal, MD ; Kroft, Robin, PhD ; Norkus, Edward P., PhD</creatorcontrib><description>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.</description><identifier>ISSN: 1525-8610</identifier><identifier>EISSN: 1538-9375</identifier><identifier>DOI: 10.1016/j.jamda.2011.04.015</identifier><identifier>PMID: 21621477</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants - therapeutic use ; DVT ; Female ; Health Personnel - education ; Humans ; Inservice Training ; Internal Medicine ; Male ; mechanical measures to prevent VTE ; Medical Audit ; Medical Education ; Nursing Homes ; Practice Guidelines as Topic ; pulmonary embolism ; Risk Assessment ; United States ; Venous thromboembolism ; Venous Thromboembolism - prevention & control ; venous thromboembolism prophylaxis in LTC ; VTE prophylaxis</subject><ispartof>Journal of the American Medical Directors Association, 2012-03, Vol.13 (3), p.303-307</ispartof><rights>2012 American Medical Directors Association, Inc.</rights><rights>Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-736a0a7de13c4c4231e433c7943f086c2285e1704fbdb447eeb49b92805ecf8a3</citedby><cites>FETCH-LOGICAL-c413t-736a0a7de13c4c4231e433c7943f086c2285e1704fbdb447eeb49b92805ecf8a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jamda.2011.04.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27911,27912,45982</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21621477$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dharmarajan, T.S., MD</creatorcontrib><creatorcontrib>Nanda, Aman, MD</creatorcontrib><creatorcontrib>Agarwal, Bikash, MD</creatorcontrib><creatorcontrib>Agnihotri, Parag, MD</creatorcontrib><creatorcontrib>Doxsie, G.L., GNP</creatorcontrib><creatorcontrib>Gokula, Murthy, MD</creatorcontrib><creatorcontrib>Javaheri, Ashkan, MD</creatorcontrib><creatorcontrib>Kanagala, M., MD</creatorcontrib><creatorcontrib>Lebelt, Anna S., MD</creatorcontrib><creatorcontrib>Madireddy, Prasuna, MD</creatorcontrib><creatorcontrib>Mahapatra, Sourya, MD</creatorcontrib><creatorcontrib>Murakonda, P., MD</creatorcontrib><creatorcontrib>Rao Muthavarapu, S. Ram, MD</creatorcontrib><creatorcontrib>Patel, Mennakshi, MD</creatorcontrib><creatorcontrib>Patterson, Christopher, MD</creatorcontrib><creatorcontrib>Soch, Kathleen, MD</creatorcontrib><creatorcontrib>Troncales, Anna, MD</creatorcontrib><creatorcontrib>Yaokim, Kamal, MD</creatorcontrib><creatorcontrib>Kroft, Robin, PhD</creatorcontrib><creatorcontrib>Norkus, Edward P., PhD</creatorcontrib><title>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)</title><title>Journal of the American Medical Directors Association</title><addtitle>J Am Med Dir Assoc</addtitle><description>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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - therapeutic use</subject><subject>DVT</subject><subject>Female</subject><subject>Health Personnel - education</subject><subject>Humans</subject><subject>Inservice Training</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>mechanical measures to prevent VTE</subject><subject>Medical Audit</subject><subject>Medical Education</subject><subject>Nursing Homes</subject><subject>Practice Guidelines as Topic</subject><subject>pulmonary embolism</subject><subject>Risk Assessment</subject><subject>United States</subject><subject>Venous thromboembolism</subject><subject>Venous Thromboembolism - prevention & control</subject><subject>venous thromboembolism prophylaxis in LTC</subject><subject>VTE prophylaxis</subject><issn>1525-8610</issn><issn>1538-9375</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks1u1DAUhSMEoqXwBEjIO2CR4L_8VQJpNLSl0lSMYMrWcuwbcEjsYieV-mI8H3ZnyoINC8vW9Tmf5Xtulr0kuCCYVO-GYpCTlgXFhBSYF5iUj7JjUrImb1ldPk5nWuZNRfBR9iyEAeMobaun2RElFSW8ro-z31sPt2Bn4yxyPfoG1i0B7X54N3UO4hpNmJCxaOPsd7QDP6G19HCKvkBYxjkkk0RX8WhUxIBHZ3pRMvHkiC5T5QF_HUxErEdjjYp3Wy9VMqGLxWiIVQinaCv9jGiCUvRGWrS6-rhC526x-h4ZTW4ANb99nj3p5RjgxWE_ya7Pz3brT_nm88XlerXJFSdszmtWSSxrDYQprjhlBDhjqm4563FTKUqbEkiNed_pjvMaoONt19IGl6D6RrKT7PWee-PdrwXCLCYTFIyjtBAbJVpK64q2ZRWVbK9U3oXgoRc33kzS3wmCRcpLDOI-L5HyEpiLmFd0vTrwl24C_dfzEFAUvN8LIP7y1oAXQRmwCrTxsRFCO_OfBz7841eHAH7CHYTBLT4GFQQRgQosvqaRSRNDCMaEs5L9Ac7MvWw</recordid><startdate>20120301</startdate><enddate>20120301</enddate><creator>Dharmarajan, T.S., MD</creator><creator>Nanda, Aman, MD</creator><creator>Agarwal, Bikash, MD</creator><creator>Agnihotri, Parag, MD</creator><creator>Doxsie, G.L., GNP</creator><creator>Gokula, Murthy, MD</creator><creator>Javaheri, Ashkan, MD</creator><creator>Kanagala, M., MD</creator><creator>Lebelt, Anna S., MD</creator><creator>Madireddy, Prasuna, MD</creator><creator>Mahapatra, Sourya, MD</creator><creator>Murakonda, P., MD</creator><creator>Rao Muthavarapu, S. Ram, MD</creator><creator>Patel, Mennakshi, MD</creator><creator>Patterson, Christopher, MD</creator><creator>Soch, Kathleen, MD</creator><creator>Troncales, Anna, MD</creator><creator>Yaokim, Kamal, MD</creator><creator>Kroft, Robin, PhD</creator><creator>Norkus, Edward P., PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120301</creationdate><title>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)</title><author>Dharmarajan, T.S., MD ; Nanda, Aman, MD ; Agarwal, Bikash, MD ; Agnihotri, Parag, MD ; Doxsie, G.L., GNP ; Gokula, Murthy, MD ; Javaheri, Ashkan, MD ; Kanagala, M., MD ; Lebelt, Anna S., MD ; Madireddy, Prasuna, MD ; Mahapatra, Sourya, MD ; Murakonda, P., MD ; Rao Muthavarapu, S. 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Ram, MD</creatorcontrib><creatorcontrib>Patel, Mennakshi, MD</creatorcontrib><creatorcontrib>Patterson, Christopher, MD</creatorcontrib><creatorcontrib>Soch, Kathleen, MD</creatorcontrib><creatorcontrib>Troncales, Anna, MD</creatorcontrib><creatorcontrib>Yaokim, Kamal, MD</creatorcontrib><creatorcontrib>Kroft, Robin, PhD</creatorcontrib><creatorcontrib>Norkus, Edward P., PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Medical Directors Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dharmarajan, T.S., MD</au><au>Nanda, Aman, MD</au><au>Agarwal, Bikash, MD</au><au>Agnihotri, Parag, MD</au><au>Doxsie, G.L., GNP</au><au>Gokula, Murthy, MD</au><au>Javaheri, Ashkan, MD</au><au>Kanagala, M., MD</au><au>Lebelt, Anna S., MD</au><au>Madireddy, Prasuna, MD</au><au>Mahapatra, Sourya, MD</au><au>Murakonda, P., MD</au><au>Rao Muthavarapu, S. Ram, MD</au><au>Patel, Mennakshi, MD</au><au>Patterson, Christopher, MD</au><au>Soch, Kathleen, MD</au><au>Troncales, Anna, MD</au><au>Yaokim, Kamal, MD</au><au>Kroft, Robin, PhD</au><au>Norkus, Edward P., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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)</atitle><jtitle>Journal of the American Medical Directors Association</jtitle><addtitle>J Am Med Dir Assoc</addtitle><date>2012-03-01</date><risdate>2012</risdate><volume>13</volume><issue>3</issue><spage>303</spage><epage>307</epage><pages>303-307</pages><issn>1525-8610</issn><eissn>1538-9375</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21621477</pmid><doi>10.1016/j.jamda.2011.04.015</doi><tpages>5</tpages></addata></record> |
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| ispartof | Journal of the American Medical Directors Association, 2012-03, Vol.13 (3), p.303-307 |
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| subjects | Aged Aged, 80 and over Anticoagulants - therapeutic use DVT Female Health Personnel - education Humans Inservice Training Internal Medicine Male mechanical measures to prevent VTE Medical Audit Medical Education Nursing Homes Practice Guidelines as Topic pulmonary embolism Risk Assessment United States Venous thromboembolism Venous Thromboembolism - prevention & control venous thromboembolism prophylaxis in LTC VTE prophylaxis |
| title | 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) |
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