title: Assessing the appropriateness of prevention and management of venous thromboembolism in Australia: a cross-sectional study.
abstract: OBJECTIVE
  The prevention and management of venous thromboembolism (VTE) is often at variance with guidelines. The CareTrack Australia (CTA) study reported that appropriate care (in line with evidence-based or consensus-based guidelines) is being provided for VTE at just over half of eligible encounters. The aim of this paper is to present and discuss the detailed CTA findings for VTE as a baseline for compliance with guidelines at a population level.
  
  
  METHODS
  The setting was 27 hospitals in 2 states of Australia.
  
  
  METHODS
  A sample of participants designed to be representative of the Australian population was recruited. Participants who had been admitted overnight during 2009 and/or 2010 were eligible. Of the 1154 CTA participants, 481(42%) were admitted overnight to hospital at least once, comprising 751 admissions. There were 279 females (58%), and the mean age was 64 years.
  
  
  METHODS
  The primary measure was compliance with indicators of appropriate care for VTE. The indicators were extracted from Australian VTE clinical practice guidelines and ratified by experts. Participants' medical records from 2009 to 2010 were analysed for compliance with 38 VTE indicators.
  
  
  RESULTS
  Of the 35,145 CTA encounters, 1078 (3%) were eligible for scoring against VTE indicators. There were 2-84 eligible encounters per indicator at 27 hospitals. Overall compliance with indicators for VTE was 51%, and ranged from 34% to 64% for aggregated sets of indicators.
  
  
  CONCLUSIONS
  The prevention and management of VTE was appropriate for only half of the at-risk patients in our sample; this provides a baseline for tracking progress nationally. There is a need for national and, ideally, international agreement on clinical standards, indicators and tools to guide, document and monitor care for VTE, and for measures to increase their uptake, particularly where deficiencies have been identified.
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Hibbert
authors.affiliation: Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia Australian Patient Safety Foundation, Adelaide, South Australia, Australia.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Hannaford
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Hooper
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Diane M
authors.initials: DM
authors.lastname: Hindmarsh
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Braithwaite
authors.affiliation: Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia Hunter Valley Research Foundation, Newcastle, New South Wales, Australia.
authors.forename: Shanthi A
authors.initials: SA
authors.lastname: Ramanathan
authors.affiliation: Adelaide Cancer Centre, Kurralta Park, South Australia, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wickham
authors.affiliation: Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia Australian Patient Safety Foundation, Adelaide, South Australia, Australia.
authors.forename: William B
authors.initials: WB
authors.lastname: Runciman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards*; D008875:Middle Aged; D054556:Venous Thromboembolism / Q000517:prevention & control* / Q000628:therapy*; D055815:Young Adult
keywords: AUDIT; GENERAL MEDICINE (see Internal Medicine); INTERNAL MEDICINE; ORTHOPAEDIC & TRAUMA SURGERY; SURGERY