title: Implementation and validation of a risk stratification method at The Ottawa Hospital to guide thromboprophylaxis in ambulatory cancer patients at intermediate-high risk for venous thrombosis.
abstract: BACKGROUND
  Cancer patients have a significantly higher risk of developing a venous thromboembolism (VTE) compared to non-cancer patients and yet studies suggest VTE risk among ambulatory cancer patients varies widely. Recently, predictive models capable of risk-stratifying a broad range of ambulatory cancer outpatients have been developed. Using the Khorana model a score of 2 was intermediate-high risk for VTE as reported by Ay and colleagues. However, validation in a broader population and methods to implement this model seamlessly into clinical practice are lacking.
  
  
  OBJECTIVE
  To create and assess the feasibility of an innovative computerized Care Process Management System (CPMS) that would automatically access electronic medical records to calculate in real-time the risk of VTE in patients with active cancer using an established VTE risk scoring system.
  
  
  METHODS
  A prospective observational study of all newly referred cancer patients at the Ottawa Regional Cancer Center, the sole cancer care provider for 1.2 million inhabitants, was conducted.
  
  
  RESULTS
  699 new referrals were determined to have a cancer diagnosis for the first time as identified by the computer software and qualified for our study and 580 were eligible. In total 25% had intermediate-high risk for VTE and during the 3-month follow up period, 16 of the 143 (11%) developed a VTE which further validates the Khorana model for identifying intermediate-high risk patients. Of the 437 patients in the low risk group 19 (4%) developed a VTE.
  
  
  CONCLUSIONS
  Newly diagnosed cancer patients can be readily stratified into intermediate-high and low risk of VTE using our novel CPMS system. This innovative tool can be used to facilitate customized management decisions regarding VTE prophylaxis for intermediate-high risk patients based their individual risk factors.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada; Thrombosis Program, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada.
authors.forename: Daniel Ben
authors.initials: DB
authors.lastname: Lustig
authors.affiliation: Department of Surgery, The Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada.
authors.forename: Rosendo
authors.initials: R
authors.lastname: Rodriguez
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada; Thrombosis Program, Ottawa Hospital Research Institute, Ottawa, ON, K1H 8L6, Canada. Electronic address: pwells@toh.on.ca.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
mesh_terms: D003199:Computer Systems; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D011446:Prospective Studies; D012306:Risk; D054556:Venous Thromboembolism / Q000517:prevention & control*
keywords: Cancer; Deep Vein Thrombosis; Prediction; Prevention; Risk Score; Venous Thromboembolism