Adherence to Venous Thromboembolism Prophylaxis Guidelines in Hospitalized Elders

描述（由申请方提供）：在静脉血栓栓塞（VTE）发生风险较低的内科住院老年患者中，存在与静脉血栓栓塞（VTE）预防不当使用相关的重要公共卫生问题。具体而言，使用抗凝剂（肝素产品）预防静脉血栓栓塞（VTE）在没有医学指征时可能是有害的，并且是一个主要的患者安全问题，也对卫生系统有显著的成本影响。为此，美国胸科医师学会（ACCP）第9版指南明确建议采用风险分层方法，而不是普遍使用抗凝剂预防VTE。尽管许多内科住院患者存在静脉血栓栓塞的高风险，但还有其他患者的风险不足以保证预防，因此在该人群中使用是不合适的。第一 本申请的目的是确定低风险老年人中抗凝剂VTE预防的不当使用的程度和范围。这一目标将通过使用来自杜克大学卫生系统电子记录的数据提取来实现，以确定（1）使用ACCP指南提出的标准的低风险老年人的患病率，以及（2）该组中抗凝剂VTE预防的使用。 指南指导的药物性静脉血栓栓塞预防也强调活动性评价。流动性是风险分层的关键组成部分。医疗服务提供者对活动性评估不佳可能是适当使用静脉血栓栓塞预防的一个重要障碍。我们的第二个目标是确定住院期间的活动水平是否被用来影响内科疾病住院老年人预防性静脉血栓栓塞的使用和持续时间。为了实现这一目标，我们将收集前瞻性的观察数据，在患者住院期间使用患者安装的加速度计客观地测量住院患者的活动性。 我们的目标是在那些伤害的风险可能超过受益的人群中提高静脉血栓栓塞预防的适当性。 我们的研究结果将为风险评估的使用以及患者活动性和静脉血栓栓塞预防之间的关系提供重要的见解。这些结果对于了解如何采取下一步措施改善住院老年人抗凝剂的适当使用和安全性至关重要。这项研究的信息可以用于未来的建议，以研究干预措施，最终改善医院的做法，在照顾老年人。 我们在杜克的研究团队是独一无二的，因为我们在所有关键研究领域都有专业知识：老年医学，医院医学，血液学和体育活动，也有长期的合作历史。因此，这个合作团队和研究计划旨在为主要研究者提供一个在老年医学和医院医学研究中追求独立职业的基础。

DESCRIPTION (provided by applicant): There are important public health concerns related to inappropriate use of venous thromboembolism (VTE) prophylaxis among medically ill hospitalized elderly patients with low risk of VTE occurrence. Specifically, use of anticoagulants (heparin products) for VTE prophylaxis when not medically indicated may be harmful, and is a major patient safety issue that also has a significant cost effect on health systems. To this end, the American College of Chest Physician (ACCP) 9th Edition guidelines explicitly recommend a risk-stratification approach, rather than universal use of anticoagulants for VTE prophylaxis. Even though many medical inpatients are at high risk for VTE, there are others whom do not have sufficient risk to warrant prophylaxis, and use in this population is inappropriate. The first aim of this application proposes to determine the magnitude and scope of inappropriate use of anticoagulant VTE prophylaxis in low risk older adults. This aim will be achieved by using data abstraction from the Duke University Health System electronic records to determine (1) the prevalence of low risk elders using criteria proposed by ACCP guidelines, and (2) anticoagulant VTE prophylaxis use in this group. Guideline directed use of pharmacologic VTE prophylaxis also emphasizes mobility evaluation. Mobility is a key component of risk stratification. Poor mobility evaluation by providers may be a significant barrier to appropriate use of VTE prophylaxis. Our second aim proposes to determine whether level of mobility during hospitalization is being used to influence use and duration of VTE prophylaxis among medically ill hospitalized elders. To achieve this aim, we will collect prospective observational data to objectively measure inpatient mobility using patient mounted accelerometers during patient hospital stays. Our goal is to improve the appropriateness of use of VTE prophylaxis among those in which the risks of harm may outweigh the benefit. Results from our study will provide important insights about use of risk assessment, and the relationship between patient mobility and VTE prophylaxis. These results are critical to understanding how to take the next steps toward improving the appropriate use and safety of anticoagulants in hospitalized older adults. Information from this study could be used in future proposals to study interventions to ultimately improve hospital practice in the care of older adults. Our investigative team at Duke is unique since we have expertise in all key fields of study: geriatrics, hospital medicine, hematology, and physical activity, that also have a longstanding history of working well with each other. As such, this collaborative team and research plan is designed to provide the principal investigator with a foundation from which to pursue an independent career in geriatric and hospital medicine research.