Tooher Rebecca, Middleton Philippa, Pham Clarabelle, Fitridge Robert, Rowe Siohban, Babidge Wendy, Maddern Guy
Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, South Australia, Australia.
Ann Surg. 2005 Mar;241(3):397-415. doi: 10.1097/01.sla.0000154120.96169.99.
To assess the effectiveness of different strategies for increasing the uptake of prophylaxis for venous thromboembolism (VTE) in hospitalized patients through a systematic review of the literature.
Literature databases and the Internet were searched from 1996 to May 2003. Studies of strategies to improve VTE prophylaxis practice were included. Studies where no policy or guideline was implemented or where the focus of the study was not VTE prevention were excluded.
Thirty studies were included. The quality of the available evidence was average with the majority of studies being uncontrolled before and after design and thus limited by the historical nature of much of the available data. Adherence to guidelines and the provision of adequate prophylaxis were poor in studies which relied on passive dissemination of guidelines. In general, the use of multiple strategies was more effective than a single strategy used in isolation. The most effective strategies incorporated a system for reminding clinicians to assess patients for VTE risk, either electronic decision-support systems or paper-based reminders, and used audit and feedback to facilitate the iterative refinement of the intervention. There were no studies adequately powered to demonstrate a reduction in rates of VTE. Insufficient evidence was available to make useful comparisons of strategies in terms of costs and resource utilization.
Passive dissemination of guidelines is unlikely to improve VTE prophylaxis practice. A number of active strategies used together, which incorporate some method for reminding clinicians to assess patients for DVT risk and assisting the selection of appropriate prophylaxis, are likely to result in the achievement of optimal outcomes.
通过对文献的系统综述，评估不同策略在提高住院患者静脉血栓栓塞症（VTE）预防措施使用率方面的有效性。
检索1996年至2003年5月的文献数据库和互联网。纳入关于改善VTE预防措施实践策略的研究。排除未实施政策或指南的研究以及研究重点不是VTE预防的研究。
纳入30项研究。现有证据质量一般，大多数研究采用前后对照设计且无对照，因此受大量现有数据的历史性限制。在依赖指南被动传播的研究中，对指南的依从性和充分预防措施的提供情况较差。总体而言，多种策略联合使用比单独使用单一策略更有效。最有效的策略包括一个提醒临床医生评估患者VTE风险的系统，无论是电子决策支持系统还是纸质提醒，并利用审核和反馈来促进干预措施的迭代优化。没有足够有力的研究能够证明VTE发生率降低。没有足够的证据可用于对策略在成本和资源利用方面进行有效比较。
指南的被动传播不太可能改善VTE预防措施的实践。多种积极策略联合使用，其中包括某种提醒临床医生评估患者DVT风险并协助选择适当预防措施的方法，可能会带来最佳效果。
