Golisch Kimberly B, Silver Casey M, Shan Ying, Guerra Andres, Janczewski Lauren M, Chung Jeanette, D'Orazio Brianna, Johnson Julie K, Prachand Vivek N, McGee Michael F, Odell David D, Yang Anthony D, Bilimoria Karl Y, Merkow Ryan P
From the Department of Surgery, ISQIC Coordinating Center, Chicago, IL, and Indianapolis, IN.
Ann Surg Open. 2025 Mar 4;6(1):e555. doi: 10.1097/AS9.0000000000000555. eCollection 2025 Mar.
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.
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.
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.
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.
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.
我们开展了一项全协作范围的质量改进项目（CQIP），重点是提高出院后静脉血栓栓塞症（VTE）化学预防的依从性。我们旨在确定与依从性相关的患者层面特征，评估参与医院之间依从率的差异，并评估高绩效和低绩效医院在依从性方面的促进因素和障碍。
VTE是腹盆腔癌症手术后最常见的可预防死亡原因，但出院后VTE化学预防的指南推荐依从性仍不理想。实施了一项CQIP，包括绩效数据的审核与反馈、工具包、指导电话和最佳实践警报。
纳入在3年研究期间于参与CQIP的医院接受住院腹盆腔癌症手术的患者。计算出院后VTE化学预防依从性的未调整和调整率。高绩效定义为提高>10%和/或依从率≥80%。我们与协作成员进行了半结构化访谈和焦点小组讨论，以确定实施的障碍和促进因素。
出院后VTE化学预防的依从性从51.8%（实施前）提高到64.5%（实施后；P<0.05）。与结直肠手术相比，接受泌尿外科手术（优势比[OR]，1.76[95%CI，1.27 - 2.43]）和妇科手术（OR，3.90[95%CI，2.73 - 5.58]）的患者更有可能接受适当的VTE化学预防。8家医院（50%）的依从率有所提高，8家（50%）为高绩效医院。实施的障碍包括外科医生缺乏支持、技术挑战和认识不足。
CQIP与出院后VTE依从率的提高相关。高绩效和低绩效医院之间存在不同的障碍。未来的协作工作应侧重于医院层面的干预措施，以改善低绩效医院的结果。
