VTE prophylaxis is a core component of inpatient care and an established quality and safety measure. Measuring rates of appropriate VTE prophylaxis in medical patients is difficult and has previously required the use of labor‐intensive chart review in order to appropriately risk‐stratify patients. A more efficient yet accurate method of risk stratification and monitoring of compliance would facilitate timely tracking and feedback of data to hospitalists.
To develop a robust, efficient, and automated mechanism to measure compliance with VTE prophylaxis among high‐risk internal medicine patients.
Our institution has utilized the Caprini risk assessment tool, a widely accepted risk score, for determining patients at risk for thromboembolic disease. To eliminate the need for manual chart review, we identified components of the Caprini risk assessment that were readily available from existing administrative databases (hospital billing data, hospital demographic data, pharmacy database). These elements were: age, history of DVT or PE, diagnosis of cancer, COPD, CHF, obesity or abnormal pulmonary function, and presence of a central venous line. We applied these criteria to our administrative database and also followed it with a manual chart review of a random sample of patients to verify the robustness of using only these elements of the Caprini assessment to assign risk scores. The manual review demonstrated high correlation (>80%) of the risk categories (low, moderate, high or highest) derived using our administrative data set. We were also able to verify whether appropriate prophylaxis was administered by using data from our inpatient pharmacy database. Each specific patient with date of admission/discharge that did not receive prophylaxis was reported to each hospitalist along with their overall rate of compliance with prophylaxis for those patients at high or highest risk for DVT. Prior to our intervention, we found that utilization of VTE prophylaxis among our hospitalists as a whole was approximately 60% in the high‐ and highest‐risk patients. Subsequent to this intervention, with quarterly reporting of these results to our physicians, we found that our rate of appropriate prophylaxis increased to 80%.
We have developed an effective tool that allows the use of administrative data to perform thromboembolic disease risk assessment and tracks rates of compliance. This allows us to provide regular feedback to physicians and has contributed to an increase in our rates of appropriate use of DVT prophylaxis in at‐risk patients.
R. Chang, none; V. Parekh, none; V. Bahl, none; S. Flanders, none.
To cite this abstract:Chang R, Parekh V, Bahl V, Flanders S. Fostering Improvement in DVT Prophylaxis Rates in High‐Risk Patients by Applying the Caprini Risk Score to an Administrative Database. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 92. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/fostering-improvement-in-dvt-prophylaxis-rates-in-highrisk-patients-by-applying-the-caprini-risk-score-to-an-administrative-database/. Accessed December 7, 2019.