Brandyn D Lau1, Adil H Haider, Michael B Streiff, Christoph U Lehmann, Peggy S Kraus, Deborah B Hobson, Franca S Kraenzlin, Amer M Zeidan, Peter J Pronovost, Elliott R Haut. 1. *Department of Surgery, Division of Acute Care Surgery, The Johns Hopkins University School of Medicine †The Armstrong Institute for Patient Safety, Johns Hopkins Medicine ‡Division of Health Sciences Informatics §Department of Anesthesiology & Critical Care Medicine ∥Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), The Johns Hopkins University School of Medicine ¶Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health #Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, MD **Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Vanderbilt University School of Medicine, Nashville, TN ††Department of Pharmacy, The Johns Hopkins Hospital ‡‡Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT §§Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
BACKGROUND: All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen. OBJECTIVES: The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services. RESEARCH DESIGN: This was a retrospective cohort study of a quality improvement intervention. SUBJECTS: The study included 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients. MEASURES: In this study, the proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis was evaluated. RESULTS: Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1% vs. 56.6%, P=0.025) and medicine (69.5% vs. 61.7%, P=0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, P=0.99) and medicine (91.8% vs. 88.0%, P=0.082). Similar findings were noted for sex disparities in the trauma cohort. CONCLUSIONS: Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.
BACKGROUND: All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen. OBJECTIVES: The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services. RESEARCH DESIGN: This was a retrospective cohort study of a quality improvement intervention. SUBJECTS: The study included 1942 hospitalized medical patients and 1599 hospitalized adult traumapatients. MEASURES: In this study, the proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis was evaluated. RESULTS: Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1% vs. 56.6%, P=0.025) and medicine (69.5% vs. 61.7%, P=0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, P=0.99) and medicine (91.8% vs. 88.0%, P=0.082). Similar findings were noted for sex disparities in the trauma cohort. CONCLUSIONS: Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.
Authors: Alexander T Cohen; Raza Alikhan; Juan I Arcelus; Jean-François Bergmann; Sylvia Haas; Geno J Merli; Alex C Spyropoulos; Victor F Tapson; Alexander G G Turpie Journal: Thromb Haemost Date: 2005-10 Impact factor: 5.249
Authors: M M Samama; A T Cohen; J Y Darmon; L Desjardins; A Eldor; C Janbon; A Leizorovicz; H Nguyen; C G Olsson; A G Turpie; N Weisslinger Journal: N Engl J Med Date: 1999-09-09 Impact factor: 91.245
Authors: Nils Kucher; Sophia Koo; Rene Quiroz; Joshua M Cooper; Marilyn D Paterno; Boris Soukonnikov; Samuel Z Goldhaber Journal: N Engl J Med Date: 2005-03-10 Impact factor: 91.245
Authors: Romana Hasnain-Wynia; David W Baker; David Nerenz; Joe Feinglass; Anne C Beal; Mary Beth Landrum; Raj Behal; Joel S Weissman Journal: Arch Intern Med Date: 2007-06-25
Authors: Alexander R Green; Dana R Carney; Daniel J Pallin; Long H Ngo; Kristal L Raymond; Lisa I Iezzoni; Mahzarin R Banaji Journal: J Gen Intern Med Date: 2007-06-27 Impact factor: 5.128
Authors: Emily M Powers; Richard N Shiffman; Edward R Melnick; Andrew Hickner; Mona Sharifi Journal: J Am Med Inform Assoc Date: 2018-11-01 Impact factor: 4.497
Authors: Henry J Michtalik; Howard T Carolan; Elliott R Haut; Brandyn D Lau; Michael B Streiff; Joseph Finkelstein; Peter J Pronovost; Nowella Durkin; Daniel J Brotman Journal: J Hosp Med Date: 2014-12-26 Impact factor: 2.960
Authors: Christopher J Pannucci; Kory I Fleming; Thomas K Varghese; John Stringham; Lyen C Huang; T Bartley Pickron; Ann Marie Prazak; Corinne Bertolaccini; Arash Momeni Journal: Ann Surg Date: 2020-10-19 Impact factor: 12.969
Authors: Sriram Ramgopal; L Nelson Sanchez-Pinto; Christopher M Horvat; Michael S Carroll; Yuan Luo; Todd A Florin Journal: Pediatr Res Date: 2022-07-29 Impact factor: 3.953
Authors: Martha-Conley E Ingram; Monica Nagalla; Ying Shan; Brian J Nasca; Arielle C Thomas; Susheel Reddy; Karl Y Bilimoria; Anne Stey Journal: JAMA Surg Date: 2022-07-01 Impact factor: 16.681
Authors: Kara L Piechowski; Stacy Elder; Leigh E Efird; Elliott R Haut; Michael B Streiff; Brandyn D Lau; Peggy S Kraus; Cynthia S Rand; Victor O Popoola; Deborah B Hobson; Norma E Farrow; Dauryne Shaffer; Kenneth M Shermock Journal: J Thromb Thrombolysis Date: 2016-11 Impact factor: 2.300
Authors: Lauren S Wakschlag; Amy L Finlay-Jones; Leigha A MacNeill; Aaron J Kaat; C Hendricks Brown; Matthew M Davis; Patricia Franklin; Cady Berkel; Sheila Krogh-Jespersen; Justin D Smith Journal: Front Public Health Date: 2022-04-14