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Venous Thromboembolism Risk Assessment at a Community Hospital: Adherence to ACCP Guidelines and Cost of Inappropriate Prophylaxis FREE TO VIEW

Matthew Awerbuck, MD; Yuri Matusov, MD; Eduardo Montoya, PhD; Justin Lee, MD; Rana Aldaw, BS; Robert Wright, BA; Justin Pearlman, MD
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UCLA Kern Medical Center, Bakersfield, CA

Chest. 2015;148(4_MeetingAbstracts):495A. doi:10.1378/chest.2270312
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SESSION TITLE: Quality Improvement to Improve Patient Safety and Reduce Healthcare Costs

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 07:30 AM - 08:30 AM

PURPOSE: To assess the rates of VTE prophylaxis compliance to ACCP guidelines in adult inpatients at a community hospital, to evaluate the impact of age on decision to anticoagulate, and to establish the cost burden associated with administration of prophylactic measures to patients who were at a low risk for developing VTE.

METHODS: All adult inpatients at a community teacing hospital from Aug-Dec 2014 were reviewed using EMR for VTE prophylaxis data. Patients were retrospectively screened using ACCP guidelines with Padua Prediction Score, to determine their VTE risk and cost was calculated for the administered prophylactic measures. Fisher’s exact test was used in evaluating ACCP guidelines compliance rates. Cost and inappropriate prophylaxis correlation was assessed using multiple regression with F-test, and the impact of age on the decision to administer VTE prophylaxis was explored using linear regression.

RESULTS: Of 311 screened patients, 41.5% were female and 48.6% were Hispanic. 60.8% were classified as high risk, of which 53.4% appropriately received prophylaxis (RR 2.78; 95% CI 1.7148, 4.5186; p=0.004). 39.2% were in the low-risk group and prophylactic measures were appropriately withheld in 67.2%; the rest received unnecessary prophylaxis at a cost of $1578.07 over 4 months ($3.74/day more than an equivalent untreated patient) (p < 0.00001; 95% CI -4.3061,3.1882). Overall compliance was 58.8%. The odds of receiving anticoagulation increased by a factor of 1.017569 (p=0.01670; 95% CI 1.0032934, 1.0323937) for every 1 year increase in age.

CONCLUSIONS: Real-world ACCP VTE prophylaxis compliance at a community hospital is under 60% of adult admissions. Many low-risk patients are inappropriately anticoagulated. Older patients are more likely to receive anticoagulation. ACCP guidelines can help reduce financial burden of unnecessary VTE prophylaxis and may improve patient safety by identifying low risk patients who do not require anticoagulation.

CLINICAL IMPLICATIONS: Compliance with guidelines is challenging and rates of compliance are unclear in community hospitals. Inappropriate anticoagulation may carry unnecessary risk; the cost of excess anticoagulation may translate to a more significant cost over a longer period of time, especially when applied to major medical centers. Limitations include lack of follow-up regarding actual VTE or bleeding events, a mixed medical-surgical population without data for admission diagnoses, and an inability to assess the administrative and labor costs of medications.

DISCLOSURE: The following authors have nothing to disclose: Matthew Awerbuck, Yuri Matusov, Eduardo Montoya, Justin Lee, Rana Aldaw, Robert Wright, Justin Pearlman

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