Impact of a Multicenter, Mentored Quality Collaborative on Hospital-Associated Venous Thromboembolism
Ian Jenkins, MD, SFHM, Clinical Professor of Medicine, Department of Medicine, University of California San Diego Health System,200 W Arbor Drive, MC 8485, San Diego, CA 92103; Telephone: 619-884-0334; Fax: 619-543-8255; E-mail: firstname.lastname@example.org
BACKGROUND: Reliable prophylaxis of hospital-associated venous thromboembolism (HA-VTE) is not achieved in many hospitals. Efforts to improve prophylaxis have had uneven results.
OBJECTIVE: To reduce HA-VTE with a scalable quality improvement collaborative.
DESIGN: A prospective, unblinded, open-intervention study with historical controls.
PARTICIPANTS AND SETTING: All adult inpatients at 35 community hospitals in California, Arizona, and Nevada.
INTERVENTIONS: A centrally supported collaborative implementing standardized VTE risk assessment and prophylaxis. Protocols were developed with 9 “pilot” sites, which received individualized mentoring. Finished protocols were disseminated to 26 “spread” sites, which received improvement webinars without mentoring. Active surveillance for real-time correction of suboptimal prophylaxis was funded in pilot sites and encouraged in spread sites. Planning and minimal improvement work began in 2011; most implementation occurred in 2012 and 2013.
MEASUREMENTS: Rates of per-protocol prophylaxis (at pilot sites), and compliance with The Joint Commission VTE measures (all sites), were monitored starting in January 2012. The International Classification of Diseases, 9th Edition-Clinical Modification codes were used to determine the rates of HA-VTE within 30 days of discharge, heparin-induced thrombocytopenia, and anticoagulation adverse events; preimplementation (2011) rates were compared with postimplementation (2014) rates.
RESULTS: Protocol-appropriate prophylaxis rates and The Joint Commission measure compliance both reached 97% in 2014, up from 70% to 89% in 2012 and 2013. Five thousand three hundred and seventy HA-VTEs occurred during 1.16 million admissions. Four hundred twenty-eight fewer HA-VTEs occurred in 2014 than in 2011 (relative risk 0.78; 95% confidence interval, 0.73-0.85). HA-VTEs fell more in pilot sites than spread sites (26% vs 20%). The rates of adverse events were reduced or unchanged.
CONCLUSIONS: Collaborative efforts were associated with improved prophylaxis rates and fewer HA-VTEs.