title: Variations in risk assessment models may contribute to the existing gap between venous thromboembolism prophylaxis guidelines and adherence.
abstract: BACKGROUND
  Risk assessment models (RAMs) may allow the clinician to determine need for deep vein thrombosis (DVT) prophylaxis. Individual healthcare facilities often develop their own RAMs. The purpose of this study was to determine: 1.) inter-RAM variability in DVT risk factors and contraindications; 2.) inter-rater variability and inter-RAM variability when applying a RAM to a standard case; and 3.) inter-rater and inter-RAM variability in outcome as far as type of prophylaxis. A convenience sample of RAMs was obtained from various institutions and ten reviewers were recruited to apply the RAMs to three patient cases.
  
  
  RESULTS
  The review resulted in 390 separate assessments. Patient 1 did not receive any chemoprophylaxis in 67% of the evaluations, patient 2 in 27% of the evaluations and patient 3 in 2.3% of the evaluations. There was statistically significant variation in the provision of chemoprophylaxis per RAM for patient 1 (p=0.001) and no significant variation for patients 2 and 3. When analyzing the rate of chemoprophylaxis per reviewer, there was statistically significant variation for patients 1 and 2 (p=0.026 and <0.0001 respectively) but not for patient 3 (p=0.123).
  
  
  CONCLUSIONS
  There may be significant inter-RAM and inter-reviewer variability when utilizing RAMs for assessing DVT risk.
authors: Assistant Professor, Pharmacy Practice Department, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, 751 Brookside Road, Stockton, CA 95207 USA.
authors: Deepti
authors: D
authors: Vyas
keywords: Deep vein thrombosis; Risk assessment model; Risk assessment protocol; Thromboprophylaxis; Venous thromboembolism