Venous thromboembolism (VTE) has been called the number one preventable cause of hospital death by the Agency for Healthcare Research and Quality. Despite the wide availability of effective prophylaxis, numerous studies have reported that appropriate VTE prophylaxis is under-prescribed for hospitalized patients. Efforts to improve VTE prevention practice have been effective to a degree; unfortunately, our preliminary data show that appropriate VTE prophylaxis practice remains suboptimal and varies significantly between individual prescribers. At most hospitals across the country, physician trainees (i.e. interns/residents), physician assistants (PAs), and nurse practitioners (NPs) are charged with prescribing appropriate VTE prophylaxis with little direct oversight or input from attending physicians. We began a pilot study in 2013 where we provided individualized feedback to one cohort of surgical interns and residents. Results from our pilot study have shown that by providing frontline prescribers with individualized feedback, we are able to improve practice and provide appropriate care for nearly 100% of all patients on a single service. We will scale up our successful pilot study to provide direct, individualized performance feedback to frontline prescribers, including interns, residents, clinical fellows, NPs, PAs, and attending physicians, about their own VTE prophylaxis prescription habits via a user- authenticated, HIPAA-compliant electronic feedback tool. We will use a mixed methods approach to determine use patterns of the performance feedback tool and identify specific barriers to prescribing optimal, risk-appropriate VTE prophylaxis for hospitalized patients. We will then disseminate the intervention to 800 interns and residents, 400 NPs and PAs, 500 clinical fellows, and 5,600 attending physicians across a health system, which contains two academic medical centers and three community hospitals. We hypothesize that regular use of this individual performance feedback tool by frontline providers will incentivize improvement in prescribing practices and positively impact outcomes. Successful completion of the proposed research will have a major, direct impact on the prevention of VTE in hospitalized patients across a variety of clinical settings. Thi electronic performance reporting tool will serve as a model that may be adapted to target hundreds of other process-linked quality measures that are driven entirely by frontline prescriber practice.
Venous thromboembolism (VTE) is a leading cause of preventable harm for hospitalized patients and prevention efforts are one of the top ten patient safety practices nationally according to the Agency for Healthcare Research and Quality. At hospitals across the country, interns, resident physicians, nurse practitioners, and physician assistants are charged with prescribing appropriate VTE prophylaxis with little direct oversight or input from attending physicians. We will scale up our successful pilot study to provide direct, individualized performance feedback to frontline prescribers about their own VTE prophylaxis prescription habits using an electronic scorecard (SA1), determine use patterns of the performance feedback tool and identify specific barriers to prescribing optimal, risk-appropriate VTE prophylaxis for hospitalized patients (SA2) and then disseminate the intervention to a wide range of clinicians in varied practice settings (SA3). Successful completion of the proposed research will develop an application that may be adapted to target hundreds of other process-linked quality measures that are driven entirely by frontline prescriber practice.
