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 栓塞症(PE)是最常见的可预防的住院死亡原因。患有癌症的退伍军人，以及 尤其是那些接受手术的患者风险特别高，高达三分之一的未接受治疗的患者(没有 预防)发展为深静脉血栓。美国胸科医师学会指南 建议在住院期间采取预防措施，并在出院后持续4周 做手术。当前医院流程措施(VA外科质量改进计划-VASQIP VTE 措施，联合委员会的外科护理改善项目SCIP-VTE-2)只检查预防 在手术过程中或在手术前后的24小时内，使他们不能充分地评估 以及提升绩效。来自伊利诺伊州外科质量改进中心的协作培训模块 合作(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、护士和病人。我们建议用VISN 12直接评估来确定 住院和门诊预防VTE风险教育模块。我们提出以下建议 具体目标： 目的1：确定多模式、以提供者为中心的教育干预是否可以改善对 大手术后静脉血栓栓塞术住院患者的化疗预防及出院后的化疗排序 在四家VISN 12医院。 H1：可扩展的术后VTE预防干预措施可以有效地解决局部护理障碍 接受住院患者的化学预防和订购出院后的化学预防。干预措施 将包括ISQIC VTE捆绑包元素：Caprini风险评估工具、提供商审计/反馈 对护士和病人进行处方习惯、风险意识教育。 目标2：确定患者和护理提供者对指南一致性护理过程中障碍的看法 从住院到门诊的过渡手术后静脉血栓栓塞术的预防。 H1：退伍军人在重大癌症手术后住院和出院后的预防依从性是不同的 由于缺乏职业教育风险意识。 目标3：执行成本确定和预算影响分析，以提高对VTE预防的依从性 指导方针。 H1：静脉血栓栓塞术化疗预防费用的增加将被静脉血栓栓塞术治疗费用的降低所抵消。 这些目标将评估ISQIC培训包的实施情况，利用综合的VHA 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 之前的工作是确定符合指南的手术后护理和外部初步测试方面的差距 伊利诺伊州外科协作组的弗吉尼亚州。本研究的创新之处在于定量和定性两个方面 方法将评估提供者如何采用手术后风险教育。这项研究还将提供新的 对手术质量改进协作(QIC)预防VTE的价值的认识，以及 护理及病人对癌症大手术后静脉血栓栓塞症风险的认知。

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.