在社区肿瘤诊所实施静脉血栓栓塞预防计划:一项队列研究

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES
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引用次数: 0

摘要

背景虽然国家指南建议对癌症门诊患者进行静脉血栓栓塞症(VTE)风险评估,并考虑对高危患者进行药物预防,但社区肿瘤诊所的预防率却很低。一个成功的指南实施模式(佛蒙特模式,VM)在一个三级肿瘤学术机构中得到了验证。我们开展了一项实施研究,以确定该模式在多点社区肿瘤实践中的成功率。研究目标是方法该研究分三个阶段进行:(1)实施前,由一个多学科团队处理根据当地情况调整 VM 的需求,包括电子病历 (EMR) 优化和临床医生教育;(2)实施根据当地情况调整的策略,这些策略由 VM 提供信息,并根据利益相关者的反馈进行调整;(3)实施后六个月对临床和实施结果进行前瞻性评估。研究结果在制定了将 VM 计划应用于社区实践的全面启动路线图后,302 名接受新治疗的癌症门诊患者在 6 个月的实施期间符合了纳入标准。100%的患者接受了VTE风险教育,98%(296人)的患者接受了VTE风险评估。在根据改良霍拉纳(Protecht)评分被评为高风险的 52 名患者(18%)中,有 14 名(27%)开始了预防治疗。项目适应性的障碍包括 EMR 优化挑战和实践层面的责任分配、时间限制、对潜在药物相互作用的担忧以及财务和保险问题。抗凝血药物预防率略有提高,这表明有必要了解并解决在这种情况下开具抗凝血药物预防处方的障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Venous thromboembolism prevention program implementation in a community oncology practice: a cohort study

Background

While national guidelines recommend Venous Thromboembolism (VTE) risk assessment in cancer outpatients and consideration of pharmacologic prophylaxis in high-risk patients, prophylaxis rates are low in community oncology practices. A successful model for guideline implementation (the Vermont Model, VM) is validated in an academic tertiary oncology setting. We undertook an implementation study to determine the success of this model in a multi-site community oncology practice. The study objectives were to: 1) adapt the VM to the community practice setting; 2) implement the adapted VM into practice; and 3) evaluate clinical and implementation outcomes.

Methods

The study was carried out in three phases: (1) Pre-implementation, a multidisciplinary team addressed the need to adapt the VM to the local context including electronic medical record (EMR) optimisation and clinician education; (2) implementation of the strategies adapted to the local context, informed by VM and adapted based on stakeholder feedback; (3) prospective evaluation of clinical and implementation outcomes at six months after implementation.

Findings

Following creation of a comprehensive initiation roadmap for the adaptation of VM program to the community practice, 302 cancer outpatients initiating new treatment met inclusion criteria over a 6 month implementation period. VTE risk education was provided to 100% of patients, and 98% (296) of patients received a VTE risk assessment. Of 52 patients (18%) who scored as high risk based on a modified Khorana (Protecht) score, 14 (27%) initiated prophylaxis. Barriers to program adaptation included EMR optimization challenges and practice-level responsibility assignment, time constraints, concern about potential drug interactions, and financial & insurance issues.

Interpretation

Implementation of a multidisciplinary VTE prevention model in the community-based oncology setting successfully increased VTE education and risk assessment rates. AC prophylaxis rates were modestly increased, highlighting the need to understand and address barriers to anticoagulant prophylaxis prescribing in this setting.

Funding

Northern New England Clinical Oncology Society Research Funding Program.

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来源期刊
CiteScore
8.00
自引率
0.00%
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0
期刊介绍: The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.
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