Eliminating Health Care Disparities With Mandatory Clinical Decision Support: The Venous Thromboembolism (VTE) Example.
BACKGROUND
All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen.


OBJECTIVE
The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services.


METHODS
This was a retrospective cohort study of a quality improvement intervention.


METHODS
The study included 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients.


METHODS
In this study, the proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis was evaluated.


RESULTS
Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1% vs. 56.6%, P=0.025) and medicine (69.5% vs. 61.7%, P=0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, P=0.99) and medicine (91.8% vs. 88.0%, P=0.082). Similar findings were noted for sex disparities in the trauma cohort.


CONCLUSIONS
Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.
*Department of Surgery, Division of Acute Care Surgery, The Johns Hopkins University School of Medicine †The Armstrong Institute for Patient Safety, Johns Hopkins Medicine ‡Division of Health Sciences Informatics §Department of Anesthesiology & Critical Care Medicine ∥Department of Surgery, Center for Surgical Trials and Outcomes Research (CSTOR), The Johns Hopkins University School of Medicine ¶Department of Health Policy and Management, The Johns Hopkins University Bloomberg School of Public Health #Department of Medicine, Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, MD **Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Vanderbilt University School of Medicine, Nashville, TN ††Department of Pharmacy, The Johns Hopkins Hospital ‡‡Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT §§Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
Brandyn D
BD
Lau
Adil H
AH
Haider
Michael B
MB
Streiff
Christoph U
CU
Lehmann
Peggy S
PS
Kraus
Deborah B
DB
Hobson
Franca S
FS
Kraenzlin
Amer M
AM
Zeidan
Peter J
PJ
Pronovost
Elliott R
ER
Haut
D000328:Adult; D001741:Black or African American; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*; D044465:White People
D000925:Anticoagulants