Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: Is there a differential effect by race?

被引：14

作者：

Owodunni, Oluwafemi P. ^{[1
]}

Haut, Elliott R. ^{[1
,2
,3
,4
,5
]}

Shaffer, Dauryne L. ^{[1
,6
]}

Hobson, Deborah B. ^{[1
,4
,6
]}

Wang, Jiangxia ^{[7
]}

Yenokyan, Gayane ^{[7
]}

Kraus, Peggy S. ^{[8
]}

Aboagye, Jonathan K. ^{[1
]}

Florecki, Katherine L. ^{[1
]}

Webster, Kristen L. W. ^{[1
,2
,3
]}

Holzmueller, Christine G. ^{[1
,2
,4
]}

Streiff, Michael B. ^{[4
,9
]}

Lau, Brandyn D. ^{[4
,5
,10
,11
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Dept Surg, Div Acute Care Surg, Baltimore, MD 21205 USA

[2] Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21205 USA

[3] Johns Hopkins Univ, Sch Med, Dept Emergency Med, Baltimore, MD 21218 USA

[4] Johns Hopkins Med, Armstrong Inst Patient Safety & Qual, Baltimore, MD 21287 USA

[5] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD 21205 USA

[6] Johns Hopkins Univ Hosp, Dept Nursing, Baltimore, MD USA

[7] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Biostat, Baltimore, MD USA

[8] Johns Hopkins Univ Hosp, Dept Pharm, Baltimore, MD 21287 USA

[9] Johns Hopkins Univ Hosp, Dept Med, Div Hematol, Baltimore, MD 21287 USA

[10] Johns Hopkins Univ Hosp, Russell H Morgan Dept Radiol & Radiol Sci, Baltimore, MD 21287 USA

[11] Johns Hopkins Univ Hosp, Div Hlth Sci Informat, Baltimore, MD 21287 USA

来源：

PLOS ONE | 2020年 / 15卷 / 01期

关键词：

ETHNIC DISPARITIES; QUALITY; ASSOCIATION; PROPHYLAXIS; TRAUMA; SAFETY;

D O I：

10.1371/journal.pone.0227339

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background Racial disparities are common in healthcare. Venous thromboembolism (VTE) is a leading cause of preventable harm, and disparities observed in prevention practices. We examined the impact of a patient-centered VTE education bundle on the non-administration of preventive prophylaxis by race. Methods A post-hoc, subset analysis (stratified by race) of a larger nonrandomized trial. Pre-post comparisons analysis were conducted on 16 inpatient units; study periods were October 2014 through March 2015 (baseline) and April through December 2015 (post-intervention). Patients on 4 intervention units received the patient-centered, nurse educator-led intervention if the electronic health record alerted a non-administered dose of VTE prophylaxis. Patients on 12 control units received no intervention. We compared the conditional odds of non-administered doses of VTE prophylaxis when patient refusal was a reason for non-administration, stratified by race. Results Of 272 patient interventions, 123 (45.2%) were white, 126 (46.3%) were black, and 23 (8.5%) were other races. A significant reduction was observed in the odds of non-administration of prophylaxis on intervention units compared to control units among patients who were black (OR 0.61; 95% CI, 0.46-0.81, p<0.001), white (OR 0.57; 95% CI, 0.44-0.75, p<0.001), and other races (OR 0.50; 95% CI, 0.29-0.88, p = 0.015). Conclusion Our finding suggests that the patient education materials, developed collaboratively with a diverse group of patients, improved patient's understanding and the importance of VTE prevention through prophylaxis. Quality improvement interventions should examine any differential effects by patient characteristics to ensure disparities are addressed and all patients experience the same benefits.

引用

页数：14

共 1 条

[1] Effect of Real-time Patient-Centered Education Bundle on Administration of Venous Thromboembolism Prevention in Hospitalized Patients
Haut, Elliott R.
Aboagye, Jonathan K.
Shaffer, Dauryne L.
Wang, Jiangxia
Hobson, Deborah B.
Yenokyan, Gayane
Sugar, Elizabeth A.
Kraus, Peggy S.
Farrow, Norma E.
Canner, Joseph K.
Owodunni, Oluwafemi P.
Florecki, Katherine L.
Webster, Kristen L. W.
Holzmueller, Christine G.
Pronovost, Peter J.
Streiff, Michael B.
Lau, Brandyn D.
JAMA NETWORK OPEN, 2018, 1 (07) : e184741

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