Modest response in translation to home management of deep venous thrombosis.
BACKGROUND
years may elapse between the publication of results of rigorous randomized trials and changes in clinical practice. It is not often that a definitive time interval can be identified that shows the time taken for published clinical trials to affect clinical practice. In the present study, we track the timelines of evidence for home treatment of deep venous thrombosis and its eventual impact on hospitalizations and early discharge.


METHODS
the number of patients discharged from short-stay hospitals throughout the United States between 1979 and 2006 with a principal diagnosis of deep venous thrombosis and the proportion discharged in ≤ 2 days was determined from The National Hospital Discharge Survey. We also attempted to identify all published articles that reported home treatment of deep venous thrombosis in unselected populations.


RESULTS
eleven years after demonstration of the safety and efficacy of home treatment, there was only a 21% decrease in the population-based incidence of hospitalizations of patients with a principal diagnosis of deep venous thrombosis. The proportion of patients with a principal diagnosis of deep venous thrombosis who were discharged in ≤ 2 days began to increase prominently after the 1996 publication of trials showing the safety and efficacy of home treatment, and continued to increase through 2006. However, the proportion discharged early remained modest (21% to 25%).


CONCLUSIONS
whether the slow implementation of home treatment reflects a cautious approach accompanied by a gradual testing of shortened hospitalization for deep venous thrombosis or other factors is uncertain.
Department of Internal Medicine and Research and Advanced Studies Program, Michigan State University College of Osteopathic Medicine, East Lansing, USA. steinp@trinity-health.org
Paul D
PD
Stein
Russell D
RD
Hull
Fadi
F
Matta
Gary L
GL
Willyerd
D000328:Adult; D000368:Aged; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012111:Residence Characteristics; D013997:Time Factors; D057170:Translational Research, Biomedical; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*