Your browser doesn't support javascript.
loading
Venous thromboembolism prevention program implementation in a community oncology practice: a cohort study.
Ades, Steven; Resnick, Yonatan; Barker, Jacob; Martin, Karlyn; Thomas, Ryan; Libby, Karen; Winters, John; Holmes, Chris.
Afiliación
  • Ades S; University of Vermont Cancer Center, 89 Beaumont Ave, Burlington, VT 05405, USA.
  • Resnick Y; New England Cancer Specialists, 100 Campus Dr Unit 108, Scarborough, ME 04074, USA.
  • Barker J; University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA.
  • Martin K; University of Vermont Cancer Center, 89 Beaumont Ave, Burlington, VT 05405, USA.
  • Thomas R; University of Vermont Cancer Center, 89 Beaumont Ave, Burlington, VT 05405, USA.
  • Libby K; University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA.
  • Winters J; New England Cancer Specialists, 100 Campus Dr Unit 108, Scarborough, ME 04074, USA.
  • Holmes C; University of Vermont Cancer Center, 89 Beaumont Ave, Burlington, VT 05405, USA.
Lancet Reg Health Am ; 38: 100866, 2024 Oct.
Article en En | MEDLINE | ID: mdl-39280881
ABSTRACT

Background:

While national guidelines recommend Venous Thromboembolism (VTE) risk assessment in cancer outpatients and consideration of pharmacologic prophylaxis in high-risk patients, prophylaxis rates are low in community oncology practices. A successful model for guideline implementation (the Vermont Model, VM) is validated in an academic tertiary oncology setting. We undertook an implementation study to determine the success of this model in a multi-site community oncology practice. The study objectives were to 1) adapt the VM to the community practice setting; 2) implement the adapted VM into practice; and 3) evaluate clinical and implementation outcomes.

Methods:

The study was carried out in three phases (1) Pre-implementation, a multidisciplinary team addressed the need to adapt the VM to the local context including electronic medical record (EMR) optimisation and clinician education; (2) implementation of the strategies adapted to the local context, informed by VM and adapted based on stakeholder feedback; (3) prospective evaluation of clinical and implementation outcomes at six months after implementation.

Findings:

Following creation of a comprehensive initiation roadmap for the adaptation of VM program to the community practice, 302 cancer outpatients initiating new treatment met inclusion criteria over a 6 month implementation period. VTE risk education was provided to 100% of patients, and 98% (296) of patients received a VTE risk assessment. Of 52 patients (18%) who scored as high risk based on a modified Khorana (Protecht) score, 14 (27%) initiated prophylaxis. Barriers to program adaptation included EMR optimization challenges and practice-level responsibility assignment, time constraints, concern about potential drug interactions, and financial & insurance issues.

Interpretation:

Implementation of a multidisciplinary VTE prevention model in the community-based oncology setting successfully increased VTE education and risk assessment rates. AC prophylaxis rates were modestly increased, highlighting the need to understand and address barriers to anticoagulant prophylaxis prescribing in this setting.

Funding:

Northern New England Clinical Oncology Society Research Funding Program.
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Lancet Reg Health Am Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Lancet Reg Health Am Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido