A Mixed-Methods Evaluation of a Collaborative-Wide Quality Improvement Project to Improve Postdischarge Venous Thromboembolism Chemoprophylaxis After Abdominopelvic Cancer Surgery.

OBJECTIVE

We studied a collaborative-wide quality improvement project (CQIP) focused on improving postdischarge venous thromboembolism (VTE) chemoprophylaxis adherence. We aimed to identify patient-level characteristics associated with adherence, evaluate differences in adherence rates among participating hospitals, and assess facilitators and barriers to adherence at high- and low-performing hospitals.

BACKGROUND

VTE is the most common preventable cause of death after abdominopelvic cancer surgery, yet adherence to guideline-recommended postdischarge VTE chemoprophylaxis remains suboptimal. A CQIP including audit and feedback of performance data, a toolkit, coaching calls, and best practice alerts was implemented.

METHODS

Patients undergoing inpatient abdominopelvic cancer surgery at a CQIP-enrolled hospital during a 3-year study period were included. Unadjusted and adjusted rates were calculated for postdischarge VTE chemoprophylaxis adherence. High performance was defined as >10% improvement and/or ≥80% adherence. We conducted semistructured interviews and focus groups with collaborative members to identify barriers and facilitators to implementation.

RESULTS

Postdischarge VTE chemoprophylaxis adherence increased from 51.8% (preimplementation) to 64.5% (postimplementation; < 0.05). Patients who underwent urologic (odds ratio [OR], 1.76 [95% CI, 1.27-2.43]) and gynecologic procedures (OR, 3.90 [95% CI, 2.73-5.58]) were more likely prescribed appropriate VTE chemoprophylaxis compared with colorectal procedures. Eight hospitals (50%) had improvement in adherence rates, and 8 (50%) were high performers. Barriers to implementation included a lack of surgeon buy-in, technical challenges, and a lack of awareness.

CONCLUSIONS

A CQIP was associated with increased postdischarge VTE adherence rates. Different barriers exist between high- and low-performing hospitals. Future collaborative work should focus on hospital-level interventions to improve low-performer results.