Multi-institution Evaluation of Adherence to Comprehensive Postoperative VTE Chemoprophylaxis
Multi-institution Evaluation of Adherence to Comprehensive Postoperative VTE Chemoprophylaxis
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DOI：
10.1097/sla.0000000000003124
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发表时间：
2020-06-01
影响因子：
9
通讯作者：
Bilimoria, Karl Y.
中科院分区：
文献类型：
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作者：
Yang, Anthony D.;Hewitt, Daniel Brock;Bilimoria, Karl Y.
目的：本研究的目的是：(1) 测量未能提供无缺陷术后静脉血栓栓塞 (VTE) 化学预防的比率，(2) 确定未能提供无缺陷 VTE 化学预防的原因，以及 (3) 检查与失败相关的患者和医院层面的因素。背景数据摘要：当前的 VTE 质量措施不够充分。由于监测偏差，VTE 结果测量对于院间比较无效。 VTE 过程测量（例如 SCIP-VTE-2）无法全面捕获患者整个住院期间的失败情况。方法：我们检查了在全州外科合作机构的 36 家医院接受结肠切除术超过 18 个月的患者对新型 VTE 化学预防过程措施的遵守情况。这项措施评估了每位患者整个住院期间的综合 VTE 化学预防，包括未给予化学预防的原因。检查了患者和医院特征与措施失败的关联。结果：SCIP-VTE-2 医院级质量测量发现 0% 至 3% 的患者 VTE 化学预防失败。相反，这项新措施揭示了 18% (736/4086) 的结肠切除术未能提供无缺陷的化学预防。失败的原因包括未订购药物（30.4%）、患者拒绝（30.3%）、剂量/频率不正确（8.2%）以及患者离开单位（3.4%）。如果在非安全网医院（OR 0.62，95% CI 0.39-0.99，P = 0.045）或 Magnet 指定医院（OR 0.45，95% CI 0.29-0.71，P = 0.001）接受治疗，患者未能通过化学预防过程措施的可能性较小。结论：与 SCIP-VTE-2 相比，我们的新质量测量揭示了 18% 的结肠切除术中 VTE 化学预防失败的情况。大多数失败是由于患者拒绝或订购错误造成的。医院应将改进工作的重点放在确保患者在整个住院期间接受 VTE 预防。
Objectives: The aims of this study were to: (1) measure the rate of failure to provide defect-free postoperative venous thromboembolism (VTE) chemoprophylaxis, (2) identify reasons for failure to provide defect-free VTE chemoprophylaxis, and (3) examine patient- and hospital-level factors associated with failure. Summary Background Data: Current VTE quality measures are inadequate. VTE outcome measures are invalidated for interhospital comparison by surveillance bias. VTE process measures (e.g., SCIP-VTE-2) do not comprehensively capture failures throughout patients' entire hospitalization. Methods: We examined adherence to a novel VTE chemoprophylaxis process measure in patients who underwent colectomies over 18 months at 36 hospitals in a statewide surgical collaborative. This measure assessed comprehensive VTE chemoprophylaxis during each patient's entire hospitalization, including reasons why chemoprophylaxis was not given. Associations of patient and hospital characteristics with measure failure were examined. Results: The SCIP-VTE-2 hospital-level quality measure identified failures of VTE chemoprophylaxis in 0% to 3% of patients. Conversely, the novel measure unmasked failure to provide defect-free chemoprophylaxis in 18% (736/4086) of colectomies. Reasons for failure included medication not ordered (30.4%), patient refusal (30.3%), incorrect dosage/frequency (8.2%), and patient off-unit (3.4%). Patients were less likely to fail the chemoprophylaxis process measure if treated at nonsafety net hospitals (OR 0.62, 95% CI 0.39-0.99, P = 0.045) or Magnet designated hospitals (OR 0.45, 95% CI 0.29-0.71, P = 0.001). Conclusions: In contrast to SCIP-VTE-2, our novel quality measure unmasked VTE chemoprophylaxis failures in 18% of colectomies. Most failures were due to patient refusals or ordering errors. Hospitals should focus improvement efforts on ensuring patients receive VTE prophylaxis throughout their entire hospitalization.