Directed evaluation of provider learning modules to prevent venous thromboembolism after major cancer surgery

静脉血栓栓塞症（VTE），包括深静脉血栓形成（DVT）和肺血栓形成。 栓塞（PE）是医院死亡的最常见可预防原因。患有癌症的退伍军人， 特别是那些接受手术的患者，风险特别高，高达三分之一的未经治疗的患者（没有 预防）发展为深静脉血栓形成。美国胸科医师学会指南 建议在整个住院过程中进行预防，并在出院后持续4周， 手术当前医院流程措施（VA手术质量改进计划-VASQIP VTE 联合委员会的外科护理改进项目SCIP-VTE-2）仅检查预防措施 在手术过程中或手术前后24小时内， 和促进业绩。来自伊利诺伊州外科质量改进的协作培训模块 协作（ISQIC）可用于提高外科医生对VTE风险和预防策略的认识， 外科护理团队、护士和患者。我们提出了一个VISN 12定向评估，以确定的影响， 关于住院和门诊VTE预防的VTE风险教育模块。我们提议下列 具体目标： 目标1：确定以提供者为重点的多模式教育干预措施是否能改善儿童接受 大型癌症手术后静脉血栓栓塞住院药物预防和出院后药物预防的顺序 在四家VISN 12医院。 H1：用于术后VTE预防的可扩展干预措施可有效解决当地护理障碍 接受住院药物预防和出院后药物预防。的干预措施 将包括ISQIC职业培训包的要素：Caprini风险评估工具、提供商的审计/反馈 处方习惯，对护士和患者进行风险意识教育。 目的2：确定患者和护理人员对指南一致性护理的障碍的看法， 从住院患者转为门诊患者的术后VTE预防。 H1：大型癌症手术后退伍军人的住院和出院后预防依从性是可变的 由于缺乏风险意识。 目的3：对增加VTE预防依从性进行成本识别和预算影响分析 指南 H1：VTE药物预防的成本增加将被VTE治疗成本的降低所抵消。 这些目标将评估ISQIC培训包的实施情况， 医疗保健提供系统和现有数据库，以改善手术结果。这些干预措施建立在 之前的工作确定了指南一致性，术后护理和初步测试以外的差距 伊利诺伊州外科协作组织的VA。本研究的创新之处在于， 方法将评估供应商如何采取手术后的风险教育。这项研究还将提供新的 了解手术质量改进协作（QIC）对预防VTE的价值，以及 护理和患者对重大癌症手术后静脉血栓栓塞风险的看法。

Venous thromboembolism (VTE), which comprises both deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common preventable cause of hospital death. Veterans with cancer, and particularly those who undergo surgery are at particularly high risk with up to one-third of untreated patients (no prophylaxis) developing deep venous thrombosis. Guidelines from the American College of Chest Physicians recommend prophylaxis throughout the hospital course and continuing post discharge for 4 weeks after surgery. Current hospital process measures (VA Surgical Quality Improvement Program-VASQIP VTE measure, Joint Commission's Surgical Care Improvement Project SCIP-VTE-2) only examine prophylaxis during the procedure or in the 24 hours around the time of surgery rendering them inadequate in evaluating and promoting performance. Collaborative training modules from the Illinois Surgical Quality Improvement Collaborative (ISQIC) are available to raise awareness of VTE risk and prevention strategies among surgeons, surgical care teams, nurses and patients. We propose a VISN 12 directed evaluation to determine the effect of VTE risk education modules on both inpatient and outpatient VTE prophylaxis. We propose the following Specific Aims: Aim1: To determine whether multi-modal, provider-focused educational interventions can improve receipt of VTE inpatient chemoprophylaxis and ordering of post-discharge chemoprophylaxis after major cancer surgery in four VISN 12 hospitals. H1: Scalable interventions for postoperative VTE prophylaxis can be effective in addressing local care barriers to receipt of inpatient chemoprophylaxis and ordering of post-discharge chemoprophylaxis. The interventions will include the ISQIC VTE Bundle elements: Caprini risk assessment tools, audit/feedback of provider prescribing habits, risk awareness education for nurses and patients. Aim 2: To identify patient and nursing provider perceptions of barriers to guideline-concordant care during the transition from inpatient to outpatient postsurgical VTE prophylaxis. H1: Inpatient and post-discharge prophylaxis adherence is variable for Veterans after major cancer surgery due to lack of VTE risk awareness. Aim 3: To perform a cost identification and budget impact analysis of increasing adherence to VTE prophylaxis guidelines. H1: The cost of increased delivery of VTE chemoprophylaxis will be offset by decreased cost of VTE treatment. These aims will evaluate the implementation of ISQIC training bundles, leveraging the integrated VHA healthcare delivery system and existing databases to improve surgical outcomes. These interventions build on prior work identifying gaps in guideline-concordant, post-surgical care and on preliminary testing outside the VA in the Illinois Surgical Collaborative. This study is innovative in that both quantitative and qualitative methods will evaluate how providers adopt post-surgical risk education. This study will also provide new knowledge on the value of a surgical quality improvement collaborative (QIC) for VTE prophylaxis, as well as nursing and patient perceptions on risk of VTE after major cancer surgery.