Eliminating health care disparities with mandatory clinical decision support the venous Thromboembolism (VTE) example

Brandyn D. Lau, Adil H. Haider, Michael B. Streiff, Christoph U. Lehmann, Peggy S. Kraus, Deborah B. Hobson, Franca S. Kraenzlin, Amer M. Zeidan, Peter J. Pronovost, Elliott R. Haut

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-Appropriate VTE prophylaxis regimen. Objectives: The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services. Research Design: This was a retrospective cohort study of a quality improvement intervention. Subjects: The study included 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients. Measures: In this study, the proportion of patients prescribed riskappropriate, best-practice VTE prophylaxis was evaluated. Results: Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1% vs. 56.6%, P= 0.025) and medicine (69.5% vs. 61.7%, P= 0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, P= 0.99) and medicine (91.8% vs. 88.0%, P= 0.082). Similar findings were noted for sex disparities in the trauma cohort. Conclusions: Despite the fact that risk-Appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.

Original languageEnglish (US)
Pages (from-to)18-24
Number of pages7
JournalMedical Care
Volume53
Issue number1
DOIs
StatePublished - Jan 20 2015
Externally publishedYes

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Clinical Decision Support Systems
Healthcare Disparities
Venous Thromboembolism
Practice Guidelines
Prescriptions
Quality Improvement
Wounds and Injuries
Medicine
Medical Informatics
Checklist
Compliance
Cohort Studies
Research Design
Retrospective Studies
Pharmacology

Keywords

  • clinical decision support
  • Disparities
  • Venous thromboembolism

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Eliminating health care disparities with mandatory clinical decision support the venous Thromboembolism (VTE) example. / Lau, Brandyn D.; Haider, Adil H.; Streiff, Michael B.; Lehmann, Christoph U.; Kraus, Peggy S.; Hobson, Deborah B.; Kraenzlin, Franca S.; Zeidan, Amer M.; Pronovost, Peter J.; Haut, Elliott R.

In: Medical Care, Vol. 53, No. 1, 20.01.2015, p. 18-24.

Research output: Contribution to journalArticle

Lau, BD, Haider, AH, Streiff, MB, Lehmann, CU, Kraus, PS, Hobson, DB, Kraenzlin, FS, Zeidan, AM, Pronovost, PJ & Haut, ER 2015, 'Eliminating health care disparities with mandatory clinical decision support the venous Thromboembolism (VTE) example', Medical Care, vol. 53, no. 1, pp. 18-24. https://doi.org/10.1097/MLR.0000000000000251
Lau, Brandyn D. ; Haider, Adil H. ; Streiff, Michael B. ; Lehmann, Christoph U. ; Kraus, Peggy S. ; Hobson, Deborah B. ; Kraenzlin, Franca S. ; Zeidan, Amer M. ; Pronovost, Peter J. ; Haut, Elliott R. / Eliminating health care disparities with mandatory clinical decision support the venous Thromboembolism (VTE) example. In: Medical Care. 2015 ; Vol. 53, No. 1. pp. 18-24.
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abstract = "Background: All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-Appropriate VTE prophylaxis regimen. Objectives: The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services. Research Design: This was a retrospective cohort study of a quality improvement intervention. Subjects: The study included 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients. Measures: In this study, the proportion of patients prescribed riskappropriate, best-practice VTE prophylaxis was evaluated. Results: Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1{\%} vs. 56.6{\%}, P= 0.025) and medicine (69.5{\%} vs. 61.7{\%}, P= 0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5{\%} vs. 85.5{\%}, P= 0.99) and medicine (91.8{\%} vs. 88.0{\%}, P= 0.082). Similar findings were noted for sex disparities in the trauma cohort. Conclusions: Despite the fact that risk-Appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.",
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