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Preventing venous thromboembolism: empowering patients and enabling patient-centered care via health information technology
Investigator (PI): Haut, Elliott
Performing Organization (PO): (Current): John Hopkins Medicine, Department of Surgery, Division of Acute Care Surgery / (410) 955-5743
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2013
Final Year: 2017
Record Source/Award ID: PCORI/CE-12-11-4489
Funding: Total Award Amount: $1,499,297
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), affects as many as 600,000 patients in the United States each year. More than 100,000 deaths annually are due to PE-more than from motor vehicle accidents, breast cancer, and AIDS combined-despite the wide availability of effective preventive strategies, according to the Surgeon General. Numerous studies have demonstrated that VTE prophylaxis is underprescribed. However, ordering of VTE prophylaxis does not ensure its administration. A retrospective review of electronic medication administration records (eMAR) for hospitalized patients at the Johns Hopkins Hospital suggests that non-administered doses of prescribed prophylaxis may be a significant issue. Of 103,160 VTE prophylaxis doses prescribed during seven months, 12% were not administered and nearly 60% of non-administered doses were documented as patient refusal. Data have suggested that documented refusal is a predictor for future non-administration, with or without patient engagement. Approximately 20% of patients missed at least two doses of VTE prophylaxis, representing more than 80% of all missed doses. Non-administered and refused doses of prescribed pharmacologic VTE prophylaxis are important, potentially modifiable reasons for suboptimal VTE prophylaxis. These data highlight the need to develop patient-centered strategies to address these deficiencies in the delivery of care. Objectives: The study objectives are to (1) enable patients to make informed decisions about their preventive care by improving the quality of patient-nurse communication about the harms of VTE and benefits of VTE prophylaxis; (2) empower patients to take an active role in their VTE preventive care; and (3) identify and facilitate active engagement of patients who are not administered doses of VTE prophylaxis using a real-time escalating alert. Methods: A multi-tiered, multidisciplinary approach will be taken to improve VTE administration rates for hospitalized patients. Patient-led, health educator-moderated training sessions for nurses will promote improved communication about VTE with patients. Informational materials developed with partnering patient stakeholders, including self-monitoring tools, will be provided to all hospitalized patients as a part of the admission package, empowering patients to take an active role in VTE prevention. When a patient initially refuses one dose of VTE prophylaxis, an eMAR-generated electronic alert (e.g., e-mail, pager, smartphone) will notify the health educator to determine how VTE prevention was communicated to the patient and, if appropriate, engage the patient in patient-centered education regarding the importance of VTE prophylaxis. Finally, if the patient continues to refuse prophylaxis, the physician will present alternatives to guideline-recommended prophylaxis to the patient to facilitate shared decision making that will better account for individual patient preferences.
MeSH Terms:
  • Communication
  • Decision Making
  • Hospitalization
  • Humans
  • Medical Informatics
  • Medication Adherence
  • * Nurse-Patient Relations
  • Patient Education as Topic /*methods
  • Patient Participation
  • Patient-Centered Care
  • Reminder Systems
  • Retrospective Studies
  • United States
  • Venous Thromboembolism /*prevention & control
Country: United States
State: Maryland
Zip Code: 21287
UI: 20143176
CTgovId: NCT02402881
Project Status: Completed
Record History: ('2017: Project extended to 2017.',)