Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: Is there a differential effect by race?


Autoři: Oluwafemi P. Owodunni aff001;  Elliott R. Haut aff001;  Dauryne L. Shaffer aff001;  Deborah B. Hobson aff001;  Jiangxia Wang aff007;  Gayane Yenokyan aff007;  Peggy S. Kraus aff008;  Jonathan K. Aboagye aff001;  Katherine L. Florecki aff001;  Kristen L. W. Webster aff001;  Christine G. Holzmueller aff001;  Michael B. Streiff aff004;  Brandyn D. Lau aff004
Působiště autorů: Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff001;  Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff002;  Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America aff003;  Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States of America aff004;  Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America aff005;  Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America aff006;  Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America aff007;  Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America aff008;  Division of Hematology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America aff009;  Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America aff010;  Division of Health Sciences Informatics, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America aff011
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227339

Souhrn

Background

Racial disparities are common in healthcare. Venous thromboembolism (VTE) is a leading cause of preventable harm, and disparities observed in prevention practices. We examined the impact of a patient-centered VTE education bundle on the non-administration of preventive prophylaxis by race.

Methods

A post-hoc, subset analysis (stratified by race) of a larger nonrandomized trial. Pre-post comparisons analysis were conducted on 16 inpatient units; study periods were October 2014 through March 2015 (baseline) and April through December 2015 (post-intervention). Patients on 4 intervention units received the patient-centered, nurse educator-led intervention if the electronic health record alerted a non-administered dose of VTE prophylaxis. Patients on 12 control units received no intervention. We compared the conditional odds of non-administered doses of VTE prophylaxis when patient refusal was a reason for non-administration, stratified by race.

Results

Of 272 patient interventions, 123 (45.2%) were white, 126 (46.3%) were black, and 23 (8.5%) were other races. A significant reduction was observed in the odds of non-administration of prophylaxis on intervention units compared to control units among patients who were black (OR 0.61; 95% CI, 0.46–0.81, p<0.001), white (OR 0.57; 95% CI, 0.44–0.75, p<0.001), and other races (OR 0.50; 95% CI, 0.29–0.88, p = 0.015).

Conclusion

Our finding suggests that the patient education materials, developed collaboratively with a diverse group of patients, improved patient’s understanding and the importance of VTE prevention through prophylaxis. Quality improvement interventions should examine any differential effects by patient characteristics to ensure disparities are addressed and all patients experience the same benefits.

Klíčová slova:

Health education and awareness – Nurses – Nursing education – Patients – Prophylaxis – Socioeconomic aspects of health – Surgical and invasive medical procedures – Venous thromboembolism


Zdroje

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