Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Health Sciences Informatics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, The Johns Hopkins University School of Public Health, Baltimore, Maryland.
J Surg Res. 2022 Dec;280:151-162. doi: 10.1016/j.jss.2022.07.015. Epub 2022 Aug 12.
Venous thromboembolism (VTE) is a frequent cause of preventable harm among hospitalized patients. Many prescribed prophylaxis doses are not administered despite supporting evidence. We previously demonstrated a patient-centered education bundle improved VTE prophylaxis administration broadly; however, patient-specific factors driving nonadministration are unclear. We examine the effects of the education bundle on missed doses of VTE prophylaxis by sex.
We performed a post-hoc analysis of a nonrandomized controlled trial to evaluate the differences in missed doses by sex. Pre-intervention and intervention periods for patients admitted to 16 surgical and medical floors between 10/2014-03/2015 (pre-intervention) and 04/2015-12/2015 (intervention) were compared. We examined the conditional odds of (1) overall missed doses, (2) missed doses due to patient refusal, and (3) missed doses for other reasons.
Overall, 16,865 patients were included (pre-intervention 6853, intervention 10,012), with 2350 male and 2460 female patients (intervention), and 6373 male and 5682 female patients (control). Any missed dose significantly reduced on the intervention floors among male (odds ratio OR 0.55; 95% confidence interval CI, 0.44-0.70, P < 0.001) and female (OR 0.59; 95% CI, 0.47-0.73, P < 0.001) patients. Similar significant reductions ensued for missed doses due to patient refusal (P < 0.001). Overall, there were no sex-specific differences (P-interaction >0.05).
Our intervention increased VTE prophylaxis administration for both female and male patients, driven by decreased patient refusal. Patient education should be applicable to a wide range of patient demographics representative of the target group. To improve future interventions, quality improvement efforts should be evaluated based on patient demographics and drivers of differences in care.
静脉血栓栓塞症（VTE）是住院患者中常见的可预防伤害的原因。尽管有支持证据，但许多规定的预防剂量并未给予。我们之前证明了以患者为中心的教育套餐广泛改善了 VTE 预防管理；然而，导致未给药的患者特定因素尚不清楚。我们检查了教育套餐对 VTE 预防漏服剂量的影响按性别划分。
我们对一项非随机对照试验进行了事后分析，以按性别评估漏服剂量的差异。比较了 2014 年 10 月至 2015 年 3 月（干预前）和 2015 年 4 月至 2015 年 12 月（干预）期间入住 16 个外科和内科病房的患者的干预前和干预期间。我们检查了（1）总体漏服剂量、（2）因患者拒绝而漏服剂量和（3）因其他原因漏服剂量的条件比值。
共有 16865 名患者被纳入（干预前 6853 名，干预后 10012 名），其中 2350 名男性和 2460 名女性患者（干预组）和 6373 名男性和 5682 名女性患者（对照组）。干预楼层的任何漏服剂量均显著减少，男性（比值比 OR 0.55；95%置信区间 CI，0.44-0.70，P<0.001）和女性（OR 0.59；95%CI，0.47-0.73，P<0.001）患者。由于患者拒绝，错过剂量也出现了类似的显著减少（P<0.001）。总体而言，没有性别特异性差异（P 交互>0.05）。
我们的干预措施增加了女性和男性患者的 VTE 预防管理，这是由于患者拒绝减少所致。患者教育应该适用于代表目标人群的广泛的患者人口统计学。为了改进未来的干预措施，应根据患者人口统计学和护理差异的驱动因素评估质量改进工作。
