title: Impact of Physician Education and a Dedicated Inferior Vena Cava Filter Tracking System on Inferior Vena Cava Filter Use and Retrieval Rates Across a Large US Health Care Region.
abstract: OBJECTIVE
  To evaluate the effects of physician familiarity with current evidence and guidelines on inferior vena cava (IVC) filter use and the availability of IVC filter tracking infrastructure on retrieval rates.
  
  
  METHODS
  Fourteen continuing medical education-approved in-hospital grand rounds covering evidence-based review of the literature on IVC filter efficacy, patient-centered outcomes, guidelines for IVC filter indications, and complications were performed across a large United States (US) health care region serving more than 3.5 million members. A computer-based IVC filter tracking system was deployed simultaneously. IVC filter use, rates of attempted retrieval, and fulfillment of guidelines for IVC filter indications were retrospectively evaluated at each facility for 12 months before intervention (n = 427) and for 12 months after intervention (n = 347).
  
  
  RESULTS
  After education, IVC filter use decreased 18.7%, with a member enrollment-adjusted decrease of 22.2%, despite an increasing IVC filter use trend for 4 years. Reduction in IVC filter use at each facility strongly correlated with physician attendance at grand rounds (r = -0.69; P = .007). Rates of attempted retrieval increased from 38.9% to 54.0% (P = .0006), with similar rates of successful retrieval (82.3% before education and 85.8% after education on first attempt). Improvement in IVC filter retrieval attempts correlated with physician attendance at grand rounds (r = 0.51; P = .051). IVC filter dwell times at first retrieval attempt were similar (10.2 wk before and 10.8 wk after).
  
  
  CONCLUSIONS
  Physician education dramatically reduced IVC filter use across a large US health care region, and represents a learning opportunity for physicians who request and place them. Education and a novel tracking system improved rates of retrieval for IVC filter devices.
authors.affiliation: Kaiser Permanente National IVC Filter Registry and Division of Vascular and Interventional Radiology, Kaiser Permanente Northern California, Santa Clara. Electronic address: stephen.wang@alumni.duke.edu.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, Kaiser Permanente Santa Clara, Santa Clara.
authors.forename: Hsien-Hwa A
authors.initials: HH
authors.lastname: Cha
authors.affiliation: Department of Internal Medicine, Kaiser Permanente Santa Clara, Santa Clara.
authors.forename: James R
authors.initials: JR
authors.lastname: Lin
authors.affiliation: Department of Imaging, Kaiser Permanente Northern California Regional Imaging, Oakland, California.
authors.forename: Bolanos
authors.initials: B
authors.lastname: Francis
authors.affiliation: Department of Radiology, Kaiser Permanente Santa Clara, Santa Clara.
authors.forename: Wakley
authors.initials: W
authors.lastname: Elizabeth
authors.affiliation: Department of Radiology, Kaiser Permanente Santa Clara, Santa Clara.
authors.forename: Porras
authors.initials: P
authors.lastname: Martin
authors.affiliation: Department of Critical Care, Kaiser Permanente Santa Clara, Santa Clara.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Rajan
mesh_terms: D002140:California; D002983:Clinical Competence; D020878:Device Removal / Q000592:standards / Q000639:trends; D004502:Education, Medical, Continuing / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006279:Health Maintenance Organizations; D006801:Humans; D007318:Inservice Training / Q000379:methods* / Q000592:standards; D010355:Patient Identification Systems / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D015397:Program Evaluation; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000592:standards / Q000639:trends; D021641:Recognition, Psychology; D012189:Retrospective Studies; D056164:Teaching Rounds; D013997:Time Factors; D016306:Vena Cava Filters / Q000592:standards / Q000639:trends