Improving hospital venous thromboembolism prophylaxis with electronic decision support.

BACKGROUND: Venous thromboembolism (VTE) disease prophylaxis rates among medical inpatients have been noted to be <50%. OBJECTIVE: Our objective was to evaluate the effectiveness and safety of a computerized decision support application to improve VTE prophylaxis. DESIGN: Observational cohort study. SETTING: Academic medical center. PATIENTS: Adult inpatients on hospital medicine and nonmedicine services. INTERVENTION: A decision support application designed by a quality improvement team was implemented on medicine services in September 2009. MEASUREMENTS: Effectiveness and safety parameters were compared on medicine services and nonmedicine (nonimplementation) services for 6-month periods before and after implementation. Effectiveness was evaluated by retrospective information system queries for rates of any VTE prophylaxis, pharmacologic VTE prophylaxis, and hospital-acquired VTE incidence. Safety was evaluated by queries for bleeding and thrombocytopenia rates. RESULTS: Medicine service overall VTE prophylaxis increased from 61.9% to 82.1% (P < 0.001), and pharmacologic VTE prophylaxis increased from 59.0% to 74.5% (P < 0.001). Smaller but significant increases were observed on nonmedicine services. Hospital-acquired VTE incidence on medicine services decreased significantly from 0.65% to 0.42% (P = 0.008) and nonsignificantly on nonmedicine services. Bleeding rates increased from 2.9% to 4.0% (P < 0.001) on medicine services and from 7.7% to 8.6% (P = 0.043) on nonmedicine services, with nonsignificant changes in thrombocytopenia rates observed on both services. CONCLUSIONS: An electronic decision support application on inpatient medicine services can significantly improve VTE prophylaxis and hospital-acquired VTE rates with a reasonable safety profile.

Standardizing race, ethnicity, and preferred language data collection in hospital information systems: results and implications for healthcare delivery and policy.

The Institute of Medicine has identified the need for healthcare organizations to collect standardized demographic data as a step toward reducing healthcare disparities. This observational study of patients discharged from a large academic medical center between 2005 and 2009, evaluates an organizational effort to standardize demographic data collection, characterizes limitations of the implementation, and assesses its utility in quality improvement and disparity reduction efforts. Primary measures include percentages of inpatient discharges with unknown race, ethnicity, and language data. Secondary measures include "ideal" cardiovascular care and readmission rates. From 2005 to 2009, the proportion of discharges with unknown race, ethnicity, or preferred language data decreased significantly. Among discharges with known ethnicity in 2009, Hispanic/Latino patients were significantly more likely to decline to specify their race or designate their race as a "Multiracial: Other Combination." No significant differences in ideal cardiovascular care were observed across demographic groups. Differences in readmission rates were observed among some groups. A provider organization can effectively standardize demographic data collection practices for use in quality improvement efforts. Current federal race categories are of limited utility for persons of Hispanic/Latino ethnicity, and performance measurement approaches that exclude demographic variables may fail to address healthcare disparities.

Improving primary percutaneous coronary intervention performance in an urban minority population using a quality improvement approach.

It has been well established that there are racial and ethnic disparities in cardiovascular care. Quality improvement initiatives have been recommended to proactively address these disparities. An initiative was implemented to improve timeliness of and access to primary percutaneous coronary intervention (PCI) procedures among myocardial infarction patients at an academic medical center serving a predominantly minority population. The effort was part of a national quality improvement collaborative focused on improving cardiovascular care for Hispanic/Latino and African American/ black populations. The proportion of primary PCI procedures performed within 90 minutes improved significantly from 17% in the first quarter of 2006 to 93% in the fourth quarter of 2008 (P < .001). There were no significant differences in the frequency with which Hispanic/Latino or African American/black patients received primary PCI therapy in comparison to nonmembers of these groups. Quality improvement techniques can improve the quality of and access to acute cardiovascular care for minority populations.