Over the last 20 years, important advances have been made in understanding the problem of venous thromboembolism. Predisposing factors are better understood, effective methods of prophylaxis are available, reliable diagnostic tests have been developed, and effective treatment for deep venous thrombosis (DVT) is available. The new effect of these recent advances should be to greatly decrease morbitity and mortality from venous thromboembolism, resulting in significant cost-savings; however, pulmonary embolism (PE) still causes an estimated 100,000 to 200,00 deaths each year. Little data exist documenting the current patterns of practice in the management of DVT/PE, and it remains unclear why so many patients continue to die from a largely preventable disease. The proposed investigation will attempt to answer this question through a community-wide study of the clinical factors, management criteria, and approaches used by an estimated 750 physicians practicing in 17 Metropolitan Worcester hospitals in their diagnosis and treatment of deep venous thrombosis and pulmonary embolism. These data will be used to identify problems in current patterns of clinical practice. An educational program will then be conducted in a randomized controlled design format to correct identified deficiencies. The effect of this educational program on selected clinical outcomes and cost-savings will be subsequently examined. These results will provide objective data to document current practices and to establish the value of specific educational interventions in improving the management of DVT/PE.
