Brown Joshua, Talbert Jeffery, Pennington Ryan, Han Qiong, Raissi Driss
1Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive HPNP #3320, Gainesville, FL 32610 USA.
2Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY USA.
Patient Saf Surg. 2018 Mar 20;12:5. doi: 10.1186/s13037-018-0151-7. eCollection 2018.
Retrieval of inferior vena cava filters (IVCFs) is important to decrease the long-term risk of complications associated with indwelling devices. Our hospital experienced low retrieval rates and implemented a low-cost intervention and evaluation for quality improvement. The working hypothesis was that a simple, mailed letter intervention could increase retrieval rates by increasing patient and primary care provider knowledge of the need for retrieval.
For all prospective patients who received a retrievable IVCF during the intervention period from January 1, 2014 to February 29, 2016, patients and their primary care providers were mailed letters encouraging contact with the clinic for evaluation of eligibility for retrieval. The main outcome was retrieval of the IVCF if clinically indicated with a secondary outcome of time-to-retrieval. A pre-intervention control group from October 1, 2011 to December 31, 2013 was used to evaluate the impact of the intervention. Competing risks, time-to-event analysis was used to compare the pre- and post-intervention period retrieval rates correcting for patients who died during follow-up.
Between the pre- and post-intervention periods, crude retrieval rates increased from 4.4% to 8.1% with a 12-fold change at comparable time points. The time-to-retrieval in the pre-intervention period was a mean (SD) of 503 (207) days with a median (IQR) of 505 (301-742). In the post-intervention period, time-to-retrieval was a mean (SD) of 119 (83) days and with median (IQR) of 128 (38-164) days.
This low-cost intervention significantly increased retrieval rates in a single clinic. However, retrieval rates remain low and can be further improved. Ongoing interventions, including improved patient follow-up and physician education, are being implemented to further improve retrieval and use of inferior vena cava filters. Implanting clinics should implement quality improvement initiatives to improve patient care and follow-up with IVCFs to ensure retrievals occur once clinically relevant in order to minimize long-term complications.
取出下腔静脉滤器（IVCF）对于降低与留置装置相关的长期并发症风险很重要。我院的取出率较低，因此实施了一项低成本干预措施并进行质量改进评估。工作假设是，一封简单的邮寄信件干预措施可以通过增加患者和初级保健提供者对取出必要性的了解来提高取出率。
对于在2014年1月1日至2016年2月29日干预期间接受可取出IVCF的所有前瞻性患者，向患者及其初级保健提供者邮寄信件，鼓励他们与诊所联系以评估取出的 eligibility。主要结局是在临床指征下取出IVCF，次要结局是取出时间。使用2011年10月1日至2013年12月31日的干预前对照组来评估干预的影响。采用竞争风险、事件发生时间分析来比较干预前后的取出率，并对随访期间死亡的患者进行校正。
在干预前后期间，粗略取出率从4.4% 提高到8.1%，在可比时间点有12倍的变化。干预前期的取出时间平均（标准差）为503（207）天，中位数（四分位间距）为505（301 - 742）天。在干预后期，取出时间平均（标准差）为119（83）天，中位数（四分位间距）为128（38 - 164）天。
这项低成本干预措施显著提高了单个诊所的取出率。然而，取出率仍然较低，可以进一步提高。正在实施包括改善患者随访和医生教育在内的持续干预措施，以进一步提高下腔静脉滤器的取出和使用。植入诊所应实施质量改进举措，以改善患者护理并对IVCF进行随访，以确保一旦临床相关就进行取出，从而将长期并发症降至最低。
