Moote Marc, Englesbe Michael, Bahl Vinita, Hu Hsou Mei, Thompson Maureen, Kubus James, Campbell Darrell
University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan, USA.
JAAPA. 2010 Jun;23(6):27-30, 32-5. doi: 10.1097/01720610-201006000-00008.
Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients, particularly surgical patients. We hypothesize that PAs are well-positioned to assist health systems with implementation of efforts to reduce the rates of this in-hospital complication and increase adherence to published standards for VTE prophylaxis.
We conducted a retrospective cohort study of general surgical patients who underwent an operation at the University of Michigan between July 2005 and June 2007. The PAs in the Department of Surgery implemented a VTE assessment and prophylaxis intervention in June 2006. Preintervention VTE risk scores were calculated using patient demographic information, operating room data, and diagnosis codes from the International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Those calculated scores were then tested on patients who had a VTE risk score documented by PAs. Postintervention VTE was determined using ICD-9-CM diagnosis codes for deep vein thrombosis (DVT) or pulmonary embolism (PE) and identified as "acquired in hospital" or readmitted with a principal diagnosis of DVT or PE within 30 days following surgery. We then compared the frequency with which patients in the preintervention and postintervention periods received recommended VTE prophylaxis.
Overall, 2,046 patients underwent surgery during the study period. There were 1,079 patients in the preintervention group and 967 patients in the postintervention group, with no systematic differences in the case mix between the two groups. For all patients with a risk score of 3 or higher (indicating high and highest risk combined), orders for appropriate prophylaxis improved from an average of 23.1% in the preintervention group to an average of 63.7% in the postintervention group. Similarly, for all patients with a risk score of 5 or higher (indicating highest risk), orders for appropriate prophylaxis improved from an average of 29.4% in the preintervention group to an average of 69.5% in the postintervention group.
Through a PA-driven VTE risk assessment process, we dramatically increased the number of patients within our health system who were prescribed appropriate orders for VTE prophylaxis according to published guidelines and according to individual patient risk.
静脉血栓栓塞症（VTE）是住院患者发病和死亡的主要原因，尤其是外科手术患者。我们假设医师助理（PAs）能够很好地协助卫生系统实施降低这种院内并发症发生率的措施，并提高对已发布的VTE预防标准的依从性。
我们对2005年7月至2007年6月在密歇根大学接受手术的普通外科患者进行了一项回顾性队列研究。外科部门的医师助理于2006年6月实施了VTE评估和预防干预措施。干预前的VTE风险评分是使用患者人口统计学信息、手术室数据以及《国际疾病分类第九版临床修订本》（ICD - 9 - CM）中的诊断代码计算得出的。然后，将这些计算出的评分应用于有医师助理记录的VTE风险评分的患者。干预后的VTE是使用ICD - 9 - CM诊断代码确定深静脉血栓形成（DVT）或肺栓塞（PE），并确定为“院内获得性”或在手术后30天内以DVT或PE的主要诊断再次入院。然后，我们比较了干预前和干预后患者接受推荐的VTE预防措施的频率。
总体而言，在研究期间有2046例患者接受了手术。干预前组有1079例患者，干预后组有967例患者，两组之间的病例组合没有系统性差异。对于所有风险评分为3或更高（表明高风险和最高风险合并）的患者，适当预防措施的医嘱从干预前组的平均23.1%提高到干预后组的平均63.7%。同样，对于所有风险评分为5或更高（表明最高风险）的患者，适当预防措施的医嘱从干预前组的平均29.4%提高到干预后组的平均69.5%。
通过由医师助理推动的VTE风险评估过程，我们显著增加了卫生系统内根据已发布指南和个体患者风险开具适当VTE预防医嘱的患者数量。
