The effect of information technology intervention on using appropriate VTE prophylaxis in non-surgical patients: A systematic review and meta-analysis

Karajizadeh, Mehrdad; Hassanipour, Soheil; Sharifian, Roxana; Tajbakhsh, Fatemeh; Saeidnia, Hamid Reza

doi:10.1177/20552076221118828

Cited by 8 publications

(11 citation statements)

References 39 publications

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“…A systematic review of VTE CDS identified a statistically significant increase in appropriate VTE prophylaxis prescribing with use of a CDS system (OR = 1.69, p = .001). 8 We failed to reach statistical significance in terms of increasing VTE prescribing; however, the absolute proportion of patients prescribed pharmacoprophylaxis correctly did increase. The studies in that review included only adult patients.…”

Section: Discussionmentioning

confidence: 70%

“…Numerous institutions have implemented clinical decision support (CDS) systems to aid providers in stratifying patients VTE risk and in ordering VTE prophylaxis when appropriate 2–7 . A systematic review of 12 studies assessing the utility of CDS systems to improve VTE pharmacologic prophylaxis prescribing found that the use of CDS was associated with a significant increase in guideline‐concordant pharmacologic prophylaxis prescribing and a decrease in the incidence of VTEs 8 …”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6][7] A systematic review of 12 studies assessing the utility of CDS systems to improve VTE pharmacologic prophylaxis prescribing found that the use of CDS was associated with a significant increase in guideline-concordant pharmacologic prophylaxis prescribing and a decrease in the incidence of VTEs. 8 CDS systems need to be updated to reflect evolving evidence and changing consensus guidelines. Numerous studies have shown that CDS systems created prior to the start of the COVID-19 pandemic have not maintained their performance during the pandemic.…”

Section: Introductionmentioning

confidence: 99%

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Clinical decision support to enhance venous thromboembolism pharmacoprophylaxis prescribing for pediatric inpatients with COVID‐19

Yan,

Parsons,

Caplan

et al. 2024

Pediatric Blood & Cancer

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ObjectiveTo design and evaluate a clinical decision support (CDS) module to improve guideline concordant venous thromboembolism (VTE) pharmacoprophylaxis prescribing for pediatric inpatients with COVID‐19.Materials and methodsThe proportion of patients who met our institutional clinical practice guideline's (CPG) criteria for VTE prophylaxis was compared to those who triggered a CDS alert, indicating the patient needed VTE prophylaxis, and to those who were prescribed prophylaxis pre and post the launch of a new VTE CDS module to support VTE pharmacoprophylaxis prescribing. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, F1‐score and accuracy of the tool were calculated for the pre‐ and post‐intervention periods using the CPG recommendation as the gold standard. Accuracy was defined as the sum of the true positives and true negatives over the sum of the true positives, false positives, true negatives, and false negatives. Logistic regression was used to identify variables associated with correct thromboprophylaxis prescribing.ResultsA significant increase in the proportion of patients triggering a CDS alert occurred in the post‐intervention period (44.3% vs. 6.9%, p < .001); however, no reciprocal increase in VTE prophylaxis prescribing was achieved (36.6% vs. 40.9%, p = .53). The updated CDS module had an improved sensitivity (55.0% vs. 13.3%), NPV (44.9% vs. 36.3%), F1‐score (66.7% vs. 23.5%), and accuracy (62.5% vs. 42.0%), but an inferior specificity (78.6% vs. 100%) and PPV (84.6% vs. 100%).DiscussionThe updated CDS model had an improved accuracy and overall performance in correctly identifying patients requiring VTE prophylaxis. Despite an increase in correct patient identification by the CDS module, the proportion of patients receiving appropriate pharmacologic prophylaxis did not change.ConclusionCDS tools to support correct VTE prophylaxis prescribing need ongoing refinement and validation to maximize clinical utility.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical decision support to enhance venous thromboembolism pharmacoprophylaxis prescribing for pediatric inpatients with COVID‐19

Yan,

Parsons,

Caplan

et al. 2024

Pediatric Blood & Cancer

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“…Prior groups have designed interventions aimed at improving adherence to VTE prophylaxis guidelines, including real‐time feedback alerts and computerized clinical decision support 13 . Meta‐analyses indicate that electronic health record (EHR) clinical decision support tools lead to increased rates of appropriate VTE prophylaxis prescription and a possible reduction in the incidence of VTE 13,14 . However, the evidence for the impact of interventions in addressing prophylaxis overuse, in particular, is sparse, with only some groups designing tools aimed at both improving underuse and overuse.…”

Section: Introductionmentioning

confidence: 99%

“…13 Meta-analyses indicate that electronic health record (EHR) clinical decision support tools lead to increased rates of appropriate VTE prophylaxis prescription and a possible reduction in the incidence of VTE. 13,14 However, the evidence for the impact of interventions in addressing prophylaxis overuse, in particular, is sparse, with only some groups designing tools aimed at both improving underuse and overuse. When rates of overuse are reported, these interventions have no significant effect.…”

Section: Introductionmentioning

confidence: 99%

Initiative to reduce inappropriate venous thromboembolism prophylaxis in an 11‐hospital safety net system: An electronic health records‐based approach

Haller

Cho

Ahn

et al. 2023

Journal of Hospital Medicine

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Background While pharmacologic prophylaxis has benefits for venous thromboembolism (VTE) prevention in high‐risk patients, unnecessary use carries potential harm, including bleeding, heparin‐induced thrombocytopenia, and patient discomfort, and should be avoided in low‐risk patients. While many quality improvement initiatives aim to reduce underuse, successful models on reducing overuse are sparse in the literature. Objective We aimed to create a quality improvement initiative to reduce overuse of pharmacologic VTE prophylaxis. Designs, Settings and Participants A quality improvement initiative was implemented across 11 safety net hospitals in New York City. Intervention The first electronic health record (EHR) intervention consisted of a VTE order panel that facilitated risk assessment and recommended VTE prophylaxis for high‐risk patients only. The second EHR intervention used a best practice advisory that alerted clinicians when prophylaxis was ordered for a patient previously deemed “low risk.” Prescribing rates were compared through a three‐segment interrupted time series linear regression design. Results Compared to the preintervention period, the first intervention did not change the rate of total pharmacologic prophylaxis immediately after implementation (1.7% relative change, p = .38) or over time (slope difference of 0.20 orders per 1000 patient days, p = .08). Compared to the first intervention period, the second intervention led to an immediate 4.5% reduction in total pharmacologic prophylaxis (p = .04) but increased thereafter (slope difference of 0.24, p = .03) such that weekly rates at the end of the study were similar to rates prior to the second intervention.

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Identifying factors that affect the use of health information technology in the treatment and management of hypertension

Faezi,

Afshar,

Rahimi

2023

BMC Med Inform Decis Mak

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Background We conducted this study with the aim of identifying factors that affect the use of health information technology in the treatment and management of hypertension. Methods This paper is a descriptive-analytic study conducted in 2022. To obtain relevant articles, databases including Scopus, Web of Science, IEEE, and PubMed were searched and the time period was between 2013 and 2022. Based on the review of similar articles, a five-point Likert scale checklist was developed in the second phase. The statistical population of the present study was specialist physicians (N = 40) and patients (N = 384). In order to analyze the data, SPSS Statistics 24 was used. To analyze the data obtained from the checklist, we used summary statistics (mean and standard deviation). Results As a result of the review literature process, 50 papers were screened, that based we can distinguish motivational and inhibitory factors affecting the use of health information technology in hypertension management. Indeed, Motivational factors and inhibitory factors can be classified into five groups: organizational, economic, technical, personal, and legal/moral factors. Based on the results of the checklist, the factors that were identified as most influential on motivation and inhibitory patients and specialist physicians’ to use of health information technology to manage and treat hypertension. Conclusion Utilizing technologies for hypertension, its management can be improved by identifying motivating and inhibiting factors. Our approach can improve the acceptability of these technologies, save costs, reduce long-term complications of hypertension, and improve patient quality of life.

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The effect of information technology intervention on using appropriate VTE prophylaxis in non-surgical patients: A systematic review and meta-analysis

Cited by 8 publications

References 39 publications

Clinical decision support to enhance venous thromboembolism pharmacoprophylaxis prescribing for pediatric inpatients with COVID‐19

Clinical decision support to enhance venous thromboembolism pharmacoprophylaxis prescribing for pediatric inpatients with COVID‐19

Initiative to reduce inappropriate venous thromboembolism prophylaxis in an 11‐hospital safety net system: An electronic health records‐based approach

Identifying factors that affect the use of health information technology in the treatment and management of hypertension

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