Physicians' Views on Utilization of an Electronic Health Record–Embedded Calculator to Assess Risk for Venous Thromboembolism among Medical Inpatients: A Qualitative Study

Abstract

Background Venous thromboembolism (VTE) causes preventable in-hospital morbidity. Pharmacologic prophylaxis reduces VTE in at-risk patients but also increases bleeding. To increase appropriate prescribing, a risk calculator to guide prophylaxis decisions was developed. Despite efforts to promote its use, providers accessed it infrequently. Objective This study aimed to understand provider perspectives on VTE prophylaxis and facilitators and barriers to using the risk calculator. Design This is a qualitative study exploring provider perspectives on VTE prophylaxis and the VTE risk calculator. Participants We interviewed attending physicians and advanced practice providers who used the calculator, and site champions who promoted calculator use. Providers were categorized by real-world usage over a 3-month period: low (<20% of the time), moderate (20–50%), or high (>50%). Approach During semistructured interviews, we asked about experiences with VTE, calculator use, perspectives on its implementation, and experiences with other risk assessment tools. Once thematic saturation was reached, transcripts were analyzed using content analysis to identify themes. Results Fourteen providers participated. Five were high utilizers, three were moderate utilizers, and six were low utilizers. Three site champions participated. Eight major themes were identified as follows: (1) ease of use, (2) perception of VTE risk, (3) harms of thromboprophylaxis, (4) overestimation of calculator use, (5) confidence in own ability, (6) underestimation of risk by calculator, (7) variability of trust in calculator, and (8) validation to withhold prophylaxis from low-risk patients. Conclusions While providers found the calculator is easy to use, routine use may be hindered by distrust of its recommendations. Inaccurate perception of VTE and bleeding risk may prevent calculator use.

The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review

“…The champion role was frequently inadequately defined [ 30 , 33 – 37 , 39 , 41 – 47 , 51 ], aligning with previous reviews [ 17 , 19 , 21 ]. As indicated by van Laere and Aggestam [ 52 ], this lack of clarity complicates the identification and comparison of champions across studies.…”

“…Those champions were described by the health personnel in the outpatient clinics as professional, updated, and engaged, and able to use the technology. Moss et al [ 47 ], USA Qualitative design, semi-structured interviews. Descriptive implementation study N = 17 17 participants.…”

“…The term champion was expressed in 20 different forms across the 23 studies included in our review. Three studies utilized multiple terms within the same study [ 32 , 47 , 48 ] and 15 different authors [ 29 , 32 , 33 , 35 – 37 , 39 – 44 , 46 , 47 , 50 ] employed the term with different compositions (Table 1 ). Furthermore, four authors utilized the term Super user [ 30 , 31 , 49 , 51 ], while four authors employed the terms Facilitator [ 38 ], IT clinician [ 48 ], Leader [ 45 ], and Manager [ 34 ], each in combination with more specific terms (such as local opinion leaders, IT nurse, or practice manager).…”

“…Most studies associated champion roles with specific professions. In seven studies, the professional title was explicitly linked to the concept of champions, such as physician champions or clinical nurse champions, or through the strategic selection of specific professions [ 29 , 33 , 36 , 40 , 43 , 47 , 50 ]. Additionally, some studies did not specify professions, but utilized terms like clinicians [ 45 ] or health professionals [ 41 ].…”

“…The champion’s role was explicitly examined in six studies [ 29 – 31 , 33 , 46 , 50 ]. Furthermore, seven studies described the champion in both the methods and results [ 32 , 36 , 38 , 47 – 49 , 51 ]. In ten of the studies, champions were solely mentioned in the results [ 34 , 35 , 37 , 39 – 45 ].…”