NCI ESSP: An Equity Focused Intervention to Improve Utilization in Guideline Concordant Extended Venous Thromboembolism Prophylaxis After Major Cancer Surgery

项目总结/摘要 重大癌症手术后的静脉血栓栓塞（VTE）是导致发病率和死亡率的重要因素。 mortality.癌症大手术后延长VTE预防（ePpx）可降低住院后风险 职业教育和职业协会推荐。然而，ePpx的利用仍然有限。此外，委员会认为， 在癌症相关结果方面存在种族差异，包括VTE和死亡率。这些不平等在更广泛的 癌症治疗表明，可能存在与ePpx的利用相关的差异。癌症护理的这一方面 没有通过癌症健康差异的透镜进行研究。ePpx利用率低的原因仍然是 巨大的知识差距。基于电子病历的临床决策支持系统 在改善住院VTE预防依从性方面有效，但尚未对ePpx进行研究。 这项工作的总体目标是确定与ePpx指南依从性相关的障碍和促进因素， 召集利益相关者制定和实施多方面的教育干预措施，包括EMR- 基于CDSS，以提高不同肿瘤学人群的指南依从性。我们的核心假设是， 存在可修改的患者和外科医生因素，这为依从性差提供了解释机制。 ePpx指南（外科医生和患者），这些因素可以通过关注公平性来克服 下面描述的干预。我们将通过这些具体目标来检验我们的假设： 具体目标1：描述利益相关者认为的ePpx指南遵守的障碍和促进因素 通过对MUSC内三家医院的不同患者和外科医生的关键线人访谈， 常规进行腹盆癌手术的卫生系统。 假设1：存在与ePpx使用相关的障碍和促进因素，这些障碍和促进因素并非来自临床数据; 一旦发现这些因素，将为目标2.1和2.2中的教育干预提供信息。 具体目标2.1：进行一项阶梯楔形随机试验，包括多方面的外科医生关注 教育和学术细节，以评估基于EMR的CDSS对提高ePpx依从性的影响 在三家选定的医院进行指导。 假设2.1：腹盆癌手术后干预会增加ePpx。 具体目标2.2：评价VTE相关出院前教育对患者ePpx依从性的影响 通过对在三家选定医院接受腹盆癌手术的患者进行的前后研究。 假设2.2：有针对性的VTE相关教育将提高患者依从性。 应用严格的定性研究方法，这一临床背景下将阐明机制， 加强指南一致性ePpx管理。将这些数据与多方面的利益相关者配对 知情的教育干预，这项工作有可能显着影响癌症护理和减轻 癌症健康差距。

Project Summary/Abstract Venous thromboembolism (VTE) following major cancer surgery is a significant contributor to morbidity and mortality. Extended VTE prophylaxis (ePpx) following major cancer surgery decreases the risk of post-hospital VTE and is recommended by professional societies. However, utilization of ePpx remains limited. Moreover, racial disparities exist for cancer associated outcomes including VTE and mortality. These inequities in broader cancer care suggest that disparities may exist related to the utilization of ePpx. This aspect of cancer care has not been studied through a lens of cancer health disparities. The reasons for low utilization of ePpx remain a significant knowledge gap. Electronic medical record (EMR)-based clinical decision support systems (CDSS) have been effective in improving adherence to inpatient VTE prophylaxis though has not been studied for ePpx. The overall objective of this work is to identify barriers and facilitators related to ePpx guideline adherence and convene stakeholders to develop and implement a multi-faceted educational intervention including an EMR- based CDSS for increasing guideline adherence in a diverse oncology population. Our central hypothesis is that modifiable patient and surgeon factors exist, which provide an explanatory mechanism for poor adherence to ePpx guidelines (both by the surgeon and patient) and that these factors may be overcome by the equity focused intervention described below. We will test our hypotheses through these specific aims: Specific Aim 1: Characterize barriers and facilitators to ePpx guideline adherence as perceived by stakeholders via key informant interviews with a diverse group of patients and surgeons at three hospitals within the MUSC Health system that routinely perform abdominopelvic cancer surgery. Hypothesis 1: Barriers and facilitators related to ePpx use exist that are not forthcoming from clinical data; once uncovered, these factors will inform the educational interventions in Aims 2.1 and 2.2. Specific Aim 2.1: Conduct a stepped-wedge randomized trial including multi-faceted surgeon-focused education and academic detailing to evaluate the impact of an EMR-based CDSS to increase adherence to ePpx guidelines at the three selected hospitals. Hypothesis 2.1: The intervention will increase ePpx following abdominopelvic cancer surgery. Specific Aim 2.2: Evaluate the impact of VTE related pre-discharge education on patient adherence to ePpx via a pre-post study of patients undergoing abdominopelvic cancer surgery at the three selected hospitals. Hypothesis 2.2: Focused VTE related education will improve patient adherence. The application of rigorous qualitative research methodology to this clinical context will elucidate mechanisms to improve administration of guideline concordant ePpx. Pairing these data with a multi-faceted, stakeholder informed educational intervention, this work has the potential to significantly impact cancer care and mitigate cancer health disparities.