title: The effect of clinical decision support on adherence to thrombosis prophylaxis guidelines in medical patients; a single center experience.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is an underestimated health problem. The administration of low molecular weight heparins (LMWH) to the appropriate patients dramatically decreases VTE incidence. Clinical decision support (CDS) might contribute to thrombosis prophylaxis guideline adherence.
  
  
  METHODS
  A computerized integrated risk score program was used to estimate VTE and bleeding risk of nonsurgical patients. A VTE risk score of ≥4 resulted in an advice to administer LMWH. We selected 64 medical patients before the introduction of CDS (T0) and 64 patients after the introduction (T1). We compared guideline compliance between these groups using chi(2) tests.
  
  
  RESULTS
  No difference between groups was found; Adherence to the guidelines at T0 was 59.4%, the same percentage of 59.4% was found at T1. To evaluate the effect of the introduction of CDS in terms of under and overtreatment we compared the prevalence of over and under treatment at T1 and T0. The OR for receiving under treatment at T1 compared to T0 is 0.48 (95% CI: 0.18-1.30), p = 0.14. The OR for overtreatment at T1 compared to T0 is 1.66 (95% CI: 0.74-3.73), p = 0.22 CONCLUSION: We found no improvement in guideline adherence towards anti thrombotic prophylaxis in medical patients after the introduction of CDS in this pilot study. There was however a non-significant shift towards over treatment. Possible explanations for these results are the increased awareness of the risk for thromboembolism induced by the study, suboptimal use of CDS and deviation from CDS advice caused by patient's preferences.
authors.affiliation: Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, Universiteitssingel 50, 6229 ER, the Netherlands. Electronic address: p.eijgenraam@maastrichtuniversity.nl.
authors.forename: Pieter
authors.initials: P
authors.lastname: Eijgenraam
authors.affiliation: Cardiovascular Center, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: nathalie.meertens@mumc.nl.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Meertens
authors.affiliation: Philips Group Innovation Research, High Tech Campus 34, 5656 AE, Eindhoven, the Netherlands. Electronic address: rene.van.den.ham@philips.com.
authors.forename: René
authors.initials: R
authors.lastname: van den Ham
authors.affiliation: Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, Universiteitssingel 50, 6229 ER, the Netherlands; Department of Internal Medicine, Cardiovascular Research Institute, Maastricht University Medical Center+, Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: h.tencate@maastrichtuniversity.nl.
authors.forename: Hugo
authors.initials: H
authors.lastname: Ten Cate
authors.affiliation: Laboratory for Clinical Thrombosis and Hemostasis, Maastricht University, Universiteitssingel 50, 6229 ER, the Netherlands; Department of Internal Medicine, Cardiovascular Research Institute, Maastricht University Medical Center+, Debyelaan 25, 6229 HX, Maastricht, the Netherlands. Electronic address: arina.tencate@maastrichtuniversity.nl.
authors.forename: Arina J
authors.initials: AJ
authors.lastname: Ten Cate-Hoek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013927:Thrombosis / Q000517:prevention & control*; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Clinical decision support; Guideline adherence; Prophylaxis; Thrombosis