Daniel Douce1, Leslie A McClure2, Pamela Lutsey3, Mary Cushman1,4, Neil A Zakai5,4. 1. Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA. 2. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA. 3. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA. 4. Department of Pathology and Laboratory Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA. 5. Department of Medicine, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA. neil.zakai@ uvm.edu.
Abstract
OBJECTIVE: To describe the uptake of outpatient DVT treatment in the United States and understand how comorbidities and socioeconomic conditions impact the decision to treat as an outpatient. DESIGN/ SETTING: The Reasons for Geographic and Racial Differences in Stroke cohort study recruited 30,329 participants between 2003 and 2007. DVT events were ascertained through 2011. MEASUREMENTS: Multivariable logistic regression was used to determine the correlates of outpatient treatment of DVT accounting for age, sex, race, education, income, urban or rural residence, and region of residence. RESULTS: Of 379 venous thromboembolism events, 141 participants had a DVT without diagnosed pulmonary embolism and that did not occur during hospitalization. Overall, 28% (39 of 141) of participants with DVT were treated as outpatients. In a multivariable model, the odds ratio for outpatient versus inpatient DVT treatment was 4.16 (95% confidence interval [CI], 1.25-13.79) for urban versus rural dwellers, 3.29 (95% CI, 1.30-8.30) for white versus black patients, 2.41 (95% CI, 1.06-5.47) for women versus men, and 1.90 (95% CI, 1.19-3.02) for every 10 years younger in age. Living outside the southeastern United States and having higher education and income were not statistically significantly associated with outpatient treatment. CONCLUSIONS: Despite known safety and efficacy, only 28% of participants with DVT received outpatient treatment. This study highlights populations in which efforts could be made to reduce hospital admissions.
OBJECTIVE: To describe the uptake of outpatient DVT treatment in the United States and understand how comorbidities and socioeconomic conditions impact the decision to treat as an outpatient. DESIGN/ SETTING: The Reasons for Geographic and Racial Differences in Stroke cohort study recruited 30,329 participants between 2003 and 2007. DVT events were ascertained through 2011. MEASUREMENTS: Multivariable logistic regression was used to determine the correlates of outpatient treatment of DVT accounting for age, sex, race, education, income, urban or rural residence, and region of residence. RESULTS: Of 379 venous thromboembolism events, 141 participants had a DVT without diagnosed pulmonary embolism and that did not occur during hospitalization. Overall, 28% (39 of 141) of participants with DVT were treated as outpatients. In a multivariable model, the odds ratio for outpatient versus inpatient DVT treatment was 4.16 (95% confidence interval [CI], 1.25-13.79) for urban versus rural dwellers, 3.29 (95% CI, 1.30-8.30) for white versus black patients, 2.41 (95% CI, 1.06-5.47) for women versus men, and 1.90 (95% CI, 1.19-3.02) for every 10 years younger in age. Living outside the southeastern United States and having higher education and income were not statistically significantly associated with outpatient treatment. CONCLUSIONS: Despite known safety and efficacy, only 28% of participants with DVT received outpatient treatment. This study highlights populations in which efforts could be made to reduce hospital admissions.
Authors: Mary Cushman; Ronald A Cantrell; Leslie A McClure; George Howard; Ronald J Prineas; Claudia S Moy; Ella M Temple; Virginia J Howard Journal: Ann Neurol Date: 2008-11 Impact factor: 10.422
Authors: Virginia J Howard; Mary Cushman; Leavonne Pulley; Camilo R Gomez; Rodney C Go; Ronald J Prineas; Andra Graham; Claudia S Moy; George Howard Journal: Neuroepidemiology Date: 2005-06-29 Impact factor: 3.282
Authors: Jodi B Segal; Dennis T Bolger; Mollie W Jenckes; Jerry A Krishnan; Michael B Streiff; John Eng; Leonardo J Tamariz; Eric B Bass Journal: Am J Med Date: 2003-09 Impact factor: 4.965
Authors: M Levine; M Gent; J Hirsh; J Leclerc; D Anderson; J Weitz; J Ginsberg; A G Turpie; C Demers; M Kovacs Journal: N Engl J Med Date: 1996-03-14 Impact factor: 91.245
Authors: M M Koopman; P Prandoni; F Piovella; P A Ockelford; D P Brandjes; J van der Meer; A S Gallus; G Simonneau; C H Chesterman; M H Prins Journal: N Engl J Med Date: 1996-03-14 Impact factor: 91.245
Authors: Mary Cushman; Geoffrey D Barnes; Mark A Creager; Jose A Diaz; Peter K Henke; Kellie R Machlus; Marvin T Nieman; Alisa S Wolberg Journal: Res Pract Thromb Haemost Date: 2020-07-08
Authors: Sarah Kelliher; Patricia Hall; Barry Kevane; Daniela Dinu; Karl Ewins; Peter MacMahon; Fionnuala Ní Áinle; Tomás Breslin Journal: Thromb J Date: 2019-07-10
Authors: Pamela L Lutsey; Rob F Walker; Richard F MacLehose; Faye L Norby; Line H Evensen; Alvaro Alonso; Neil A Zakai Journal: J Am Heart Assoc Date: 2021-10-08 Impact factor: 5.501
Authors: Jeffrey Kline; David Adler; Naomi Alanis; Joseph Bledsoe; Daniel Courtney; James D'Etienne; Deborah B Diercks; John Garrett; Alan E Jones; David MacKenzie; Troy Madsen; Andrew Matuskowitz; Bryn Mumma; Kristen Nordenholz; Justine Pagenhardt; Michael Runyon; William Stubblefield; Christopher Willoughby Journal: BMJ Open Date: 2020-10-01 Impact factor: 2.692