Using Implementation Science-Informed Strategies to Improve Transitions of Care for Patients with Venous Thromboembolism.
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, are common causes of preventable hospital death. Most VTEs diagnosed in the outpatient setting are directly linked to a recent hospitalization or surgery. A type 2 effectiveness-implementation hybrid study was condu...
| Published in: | Joint Commission Journal on Quality & Patient Safety Vol. 51; no. 4; pp. 241 - 252 |
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| Main Authors: | , , , , , , , |
| Format: | research Journal Article |
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Elsevier B.V.
Apr2025
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=183436132&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 183436132 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15537250 17W5 jtl: Joint Commission Journal on Quality & Patient Safety issn: 15537250 maglogo: N pubinfo: dt: Apr2025 vid: 51 iid: 4 pid: 82545 pub: Elsevier B.V. place: Philadelphia, Pennsylvania artinfo: ui: 183436132 183436132 183436132 10.1016/j.jcjq.2024.12.007 183436132 ppf: 241 ppct: 11 formats: tig: atl: Using Implementation Science-Informed Strategies to Improve Transitions of Care for Patients with Venous Thromboembolism. aug: au: Ciemins, Elizabeth L. Grant, Cori C. Tallam, Meghana Rattelman, Cori Lindberg, Curt Williams, Rae Ann Christensen, Paige S. Thygeson, N. Marcus sug: subj: Venous Thromboembolism Therapy Transitional Care Continuity of Patient Care Implementation Science Health Resource Utilization Human Inpatients Qualitative Studies Comparative Studies Hospitalization Ambulatory Care Descriptive Statistics Health Services Accessibility Quality Improvement Communication Protocols ab: Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, are common causes of preventable hospital death. Most VTEs diagnosed in the outpatient setting are directly linked to a recent hospitalization or surgery. A type 2 effectiveness-implementation hybrid study was conducted to develop and implement targeted interventions to improve care for patients with VTE in six US health systems. Primary outcomes included (1) 7-day follow-up after VTE diagnosis (phone calls, office visits); (2) VTE–related hospitalizations or emergency department (ED) visits within 45 days of acute VTE diagnosis; and (3) anticoagulant-associated adverse drug events (ADEs). Qualitative comparative analysis (QCA) identified interventions associated with improved care for patients with VTE. Among 1,265 patients, follow-up within 7 days of an index VTE diagnosis improved from 25.2% to 33.6% (p < 0.0001); among 2,002 patients, hospitalizations/ED visits within 45 days of VTE diagnosis decreased across settings from 7.8% to 6.3% (p = 0.033), and the rate of anticoagulant-associated ADEs remained low (3.1% to 3.4%, p = 0.528). Factors characteristic of improving 7-day follow-up included combinations of (1) safer prescribing and management of anticoagulants and standardized protocols with centralized care processes or (2) safer prescribing and management of anticoagulants with improved care team communication and expanded anticoagulation clinic access for patients prescribed direct oral anticoagulants. Factors associated with 45-day hospitalization/ED visits improvement included high baseline rates of 7-day follow-up, high rates of baseline 45-day hospitalization/ED visits (larger opportunity), improved care team communication, and improved standardization and centralization of protocols. Combinations of interventions, tailored to local context and team dynamics, improved ambulatory follow-up rates and reduced VTE–related utilization. Health systems may benefit from considering novel, implementation science–informed strategies to foster improvement. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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