title: Implementation of an acute venous thromboembolism clinical pathway reduces healthcare utilization and mitigates health disparities.
abstract: BACKGROUND
  Acute venous thromboembolism (VTE) is prevalent, expensive, and deadly. Published data at our institution identified significant VTE care variation based on payer source. We developed a VTE clinical pathway to standardize care, decrease hospital utilization, provide education, and mitigate disparities.
  
  
  METHODS
  Target population for our interdisciplinary pathway was acute medical VTE patients. The intervention included order sets, system-wide education, follow-up phone calls, and coordinated posthospital care. Study data (n = 241) were compared to historical data (n = 234), evaluating outcomes of hospital admission, length of stay (LOS), and reutilization, stratified by payer source.
  
  
  RESULTS
  A total of 241 patients entered the VTE clinical care pathway: 107 with deep venous thrombosis (44.4%) and 134 with a pulmonary embolism (55.6%). Within the pathway, uninsured VTE patients were admitted at a lower rate than insured patients (65.9 vs 79.1%; P = 0.032). LOS decreased from 4.4 to 3.1 days (P < 0.001) for admitted VTE patients and from 5.9 to 3.1 days among uninsured patients (P = 0.0006). Overall, 30-day emergency department recidivism remained 11%, but declined (17.9% to 13.6%) among uninsured patients (P = 0.593). Fewer pathway patients (5.8%) were readmitted compared to historical patients (9.4%, P = 0.254). Individual cost of care decreased from $7610 to $5295 (P < 0.005) for any VTE patient, and from $9953 to $4304 (P = 0.001) per uninsured patient.
  
  
  CONCLUSIONS
  Implementing an interdisciplinary, clinical pathway standardized care for VTE patients and dramatically reduced hospital utilization and cost, particularly among uninsured patients. Results of this novel study demonstrate a model for improving transitional care coordination with local community health clinics and delivering care to vulnerable populations. Other disease populations may benefit from the development of a similar model.
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Misky
authors.forename: Todd
authors.initials: T
authors.lastname: Carlson
authors.forename: Elaina
authors.initials: E
authors.lastname: Thompson
authors.forename: Toby
authors.initials: T
authors.lastname: Trujillo
authors.forename: Kristen
authors.initials: K
authors.lastname: Nordenholz
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team / Q000191:economics / Q000639:trends*; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000191:economics / Q000628:therapy*