Venous thromboembolism prophylaxis among medical patients at US hospitals.
BACKGROUND
Chemoprophylaxis is recommended for medical patients at moderate to high risk of venous thromboembolism (VTE) and is now a requirement of the Joint Commission on Accreditation of Healthcare Organizations. To see who receives prophylaxis and how far hospitals will need to go to meet this requirement, we examined VTE prophylaxis patterns at US hospitals.


METHODS
We conducted a retrospective cohort study of adult patients with seven medical diagnoses considered to carry moderate to high risk of VTE at 376 acute care facilities in 2004-2005. We excluded patients on warfarin or with hospital stays of <2 days. VTE prophylaxis was assessed by billing codes for any heparin or compression device. We classified patient risk using a VTE risk prediction model.


RESULTS
Of 351,535 patients included, 36% received prophylaxis by hospital day 2. Prophylaxis rates were highest among patients with certain VTE risk factors, including mechanical ventilation (67%), restraints (57%), central lines (55%), obesity (46%), and prior VTE (44%). The median hospital rate was 31% (IQR 19% to 42%); only 3% of hospitals had rates >70%. Compared to patients at low risk of VTE (<0.05%), patients at high risk (>1.0%) were more likely to receive prophylaxis (52% vs. 34%, p < 0.001). Hospitals with high rates of prescribing for high-risk patients also had high rates for low-risk patients.


CONCLUSIONS
VTE prophylaxis rates at US hospitals are substantially below Joint Commission targets, even for patients at highest risk of VTE.
Rothberg
Michael B
MB
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA 01199, USA. Michael.Rothberg@bhs.org
Lahti
Maureen
M
Pekow
Penelope S
PS
Lindenauer
Peter K
PK
D000328:Adult; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D014481:United States; D054556:Venous Thromboembolism / Q000517:prevention & control*