title: Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism : a cohort study.
abstract: OBJECTIVE
  Hospitalization for acute medical illness is associated with increased risk of venous thromboembolism (VTE). Although efforts designed to increase use of pharmacologic VTE prophylaxis are intended to reduce hospital-associated VTE, whether higher rates of prophylaxis reduce VTE in medical patients is unknown.
  
  
  OBJECTIVE
  To examine the association between pharmacologic VTE prophylaxis rates and hospital-associated VTE.
  
  
  METHODS
  Retrospective, multicenter cohort study conducted at 35 Michigan hospitals participating in a statewide quality collaborative from January 1, 2011, through September 13, 2012. Trained medical record abstractors at each hospital collected data from 31 260 general medical patients. Use of VTE prophylaxis on admission, VTE risk factors, and VTE events 90 days after hospital admission were recorded using a combination of medical record review and telephone follow-up. Hospitals were grouped into tertiles of performance based on rate of pharmacologic prophylaxis use on admission for at-risk patients.
  
  
  METHODS
  Association between hospital performance and time to development of VTE within 90 days of hospital admission.
  
  
  RESULTS
  A total of 14 563 of 20 794 patients (70.0%) eligible for pharmacologic prophylaxis received prophylaxis on admission. The rates of pharmacologic prophylaxis use at hospitals in the high-, moderate-, and low-performance tertiles were 85.8%, 72.6%, and 55.5%, respectively. A total of 226 VTE events occurred during 1 765 449 days of patient follow-up. Compared with patients at hospitals in the highest-performance tertile, the hazard of VTE in patients at hospitals in moderate-performance (hazard ratio, 1.10; 95% CI, 0.74-1.62) and low-performance (hazard ratio, 0.96, 95% CI, 0.63-1.45) tertiles did not differ after adjusting for potential confounders. Results remained robust when examining mechanical prophylaxis, prophylaxis use throughout the hospitalization, and subsequent inpatient stays after discharge from the index hospitalization.
  
  
  CONCLUSIONS
  The occurrence of 90-day VTE in medical patients after hospitalization is low. Patients who receive care at hospitals that have lower rates of pharmacologic prophylaxis do not have higher adjusted hazards of VTE, even after accounting for individual receipt of pharmacologic prophylaxis. Efforts to increase rates of pharmacologic VTE prophylaxis in hospitalized medical patients may not substantively reduce this adverse outcome.
authors.affiliation: Michigan Hospital Medicine Safety Consortium2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
authors.affiliation: Michigan Hospital Medicine Safety Consortium2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
authors.forename: M Todd
authors.initials: MT
authors.lastname: Greene
authors.affiliation: Michigan Hospital Medicine Safety Consortium2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
authors.forename: Paul
authors.initials: P
authors.lastname: Grant
authors.affiliation: Michigan Hospital Medicine Safety Consortium3Hurley Medical Center, Flint, Michigan.
authors.forename: Scott
authors.initials: S
authors.lastname: Kaatz
authors.affiliation: Michigan Hospital Medicine Safety Consortium4Henry Ford Health System, Detroit, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Paje
authors.affiliation: Michigan Hospital Medicine Safety Consortium5Oakwood Health System, Dearborn Heights, Michigan.
authors.forename: Bobby
authors.initials: B
authors.lastname: Lee
authors.affiliation: Michigan Hospital Medicine Safety Consortium6Spectrum Health, Grand Rapids, Michigan.
authors.forename: James
authors.initials: J
authors.lastname: Barron
authors.affiliation: Michigan Hospital Medicine Safety Consortium2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor7VA Ann Arbor Health Care System, Ann Arbor, Michigan.
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
authors.affiliation: Blue Cross Blue Shield of Michigan, Detroit.
authors.forename: David
authors.initials: D
authors.lastname: Share
authors.affiliation: Michigan Hospital Medicine Safety Consortium2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor7VA Ann Arbor Health Care System, Ann Arbor, Michigan.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants