The effect of information technology intervention on using appropriate VTE prophylaxis in non-surgical patients: A systematic review and meta-analysis

Acceptance of artificial intelligence clinical assistant decision support system to prevent and control venous thromboembolism among healthcare workers: an extend Unified Theory of Acceptance and Use of Technology Model

Background

Venous thromboembolism (VTE) is an important global health problem and the third most prevalent cardiovascular disorder. It has been proven that computerized tools were helpful in the prevention and control of VTE. However, studies that focused on the acceptance of computerized tools for VTE prevention among healthcare workers were limited.

Objective

This study aims to explore what factors are influencing healthcare workers' acceptance of the Artificial Intelligence Clinical Assistant Decision Support System (AI-CDSS) for VTE prevention based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT).

Methods

We conducted a cross-sectional survey among healthcare workers in three grade-A tertiary hospitals in Shanxi, China. Statistically, the hypothesized model was evaluated by AMOS structural equation modeling.

Results

510 (72.86%) valid surveys were collected in total. The results showed that performance expectancy (β = 0.45, P < 0.001), effort expectancy (β = 0.21, P < 0.001), and top management support (β = 0.30, P < 0.001) positively influenced healthcare workers' intention. Top management support was an antecedent of performance expectancy (β = 0.41 , P < 0.001), social influence (β = 0.57, P < 0.001), effort expectancy (β = 0.61, P < 0.001), and information quality (β = 0.59, P < 0.001). In addition, Social influence positively influenced performance expectancy (β = 0.52, P < 0.001), and information quality positively influenced system quality (β = 0.65, P < 0.001). Social influence did not influence nurses' behavioral intention (β = 0.06, p = 0.376), but negatively influenced clinicians' behavioral intention in the model (β = -0.19, P < 0.001). System quality positively influenced nurses' behavioral intention; (β = 0.16, P < 0.001), and information quality positively influenced clinicians' behavioral intention (β = 0.15, p = 0.025).

Conclusion

With this model explaining 76.3% variance of the behavioral intention variable, this study could be useful as a reference for hospital administrators to evaluate future developments and facilitate the implementation of AI-CDSS for VTE prevention.

A clinical decision support tool for improving venous thromboembolism risk assessment and thromboprophylaxis prescribing compliance within an electronic medication management system: a retrospective observational study

BACKGROUND

Despite various interventions to improve best-practice venous thromboembolism (VTE) prevention measures within hospitals, compliance remains poor. For health services utilising electronic medication management systems (eMMS), implementation of clinical decision support (CDS) tools could address this gap.

AIM

To evaluate whether local implementation of an integrated electronic alert system linked with a computerised physician order entry (CPOE)-based order set for VTE risk assessment within an eMMS improves the rates of timely VTE risk assessment and guideline-compliant VTE prophylaxis prescribing among hospitalised patients.

METHOD

A retrospective observational study conducted among hospitalised patients pre- and post-implementation of an electronic alert system combined with a CPOE-based order set to prompt VTE risk assessment documentation and VTE prophylaxis prescribing within a single tertiary hospital. Admissions were consecutively screened over 7-day periods before and after implementation for inclusion and assessed for compliance with a local VTE prevention protocol.

RESULTS

Eight hundred and fifty patients (458 pre-intervention, 392 post-intervention) were included for evaluation. Rates of VTE risk assessment documentation within 24 h of admission increased by 29.9% (p < 0.001). Guideline-compliant VTE prophylaxis improved by 10.4% (p < 0.001). Patients with completed VTE risk assessments were significantly more likely to receive guideline-compliant VTE prophylaxis, compared to patients without documented VTE risk assessments (19.3% difference, p < 0.001). After adjusting for demographic differences, the odds of achieving positive outcomes significantly increased across all measures, with adjusted odds ratios ranging from 1.95 to 4.89 (p < 0.001).

CONCLUSION

Local implementation of CDS featuring CPOE within the eMMS improved rates of VTE risk assessment documentation and guideline-compliant VTE prophylaxis prescribing.

The Clot Stops Here: Insights Into Venous Thromboembolism Prophylaxis Adherence From Two Cases

Pharmacologic venous thromboembolism (VTE) prophylaxis is effective and essential in the inpatient setting for medically ill patients to prevent deep venous thromboses (DVTs) and pulmonary embolisms (PEs), especially in high-risk patients such as those with limited mobility and underlying malignancy. It is less clear how the primary team, including the nurses and physicians, work together to ensure adherence to VTE prophylaxis during hospitalizations, especially amongst different institutions with varied practices. This case series describes two cases of healthcare-associated VTE after refusal of VTE prophylaxis for several days and the resulting complications, including morbidity and mortality. In light of these two cases and recognition that healthcare-associated VTE is a wider public health problem, we suggest a multi-disciplinary and standardized protocol for physicians to follow to ensure VTE prophylaxis adherence that takes into account a VTE risk assessment calculator such as the Padua or Caprini scores. Furthermore, physicians should acknowledge VTE prophylaxis refusal, counsel patients, and document their findings in high-risk patients on a daily basis. This would be a full-circle approach that encourages patient education about this commonplace yet critical practice and the potential consequences of non-adherence.

Clinical decision support to enhance venous thromboembolism pharmacoprophylaxis prescribing for pediatric inpatients with COVID-19

OBJECTIVE

To design and evaluate a clinical decision support (CDS) module to improve guideline concordant venous thromboembolism (VTE) pharmacoprophylaxis prescribing for pediatric inpatients with COVID-19.

MATERIALS AND METHODS

The proportion of patients who met our institutional clinical practice guideline's (CPG) criteria for VTE prophylaxis was compared to those who triggered a CDS alert, indicating the patient needed VTE prophylaxis, and to those who were prescribed prophylaxis pre and post the launch of a new VTE CDS module to support VTE pharmacoprophylaxis prescribing. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, F1-score and accuracy of the tool were calculated for the pre- and post-intervention periods using the CPG recommendation as the gold standard. Accuracy was defined as the sum of the true positives and true negatives over the sum of the true positives, false positives, true negatives, and false negatives. Logistic regression was used to identify variables associated with correct thromboprophylaxis prescribing.

RESULTS

A significant increase in the proportion of patients triggering a CDS alert occurred in the post-intervention period (44.3% vs. 6.9%, p < .001); however, no reciprocal increase in VTE prophylaxis prescribing was achieved (36.6% vs. 40.9%, p = .53). The updated CDS module had an improved sensitivity (55.0% vs. 13.3%), NPV (44.9% vs. 36.3%), F1-score (66.7% vs. 23.5%), and accuracy (62.5% vs. 42.0%), but an inferior specificity (78.6% vs. 100%) and PPV (84.6% vs. 100%).

DISCUSSION

The updated CDS model had an improved accuracy and overall performance in correctly identifying patients requiring VTE prophylaxis. Despite an increase in correct patient identification by the CDS module, the proportion of patients receiving appropriate pharmacologic prophylaxis did not change.

CONCLUSION

CDS tools to support correct VTE prophylaxis prescribing need ongoing refinement and validation to maximize clinical utility.

Identifying factors that affect the use of health information technology in the treatment and management of hypertension

BACKGROUND

We conducted this study with the aim of identifying factors that affect the use of health information technology in the treatment and management of hypertension.

METHODS

This paper is a descriptive-analytic study conducted in 2022. To obtain relevant articles, databases including Scopus, Web of Science, IEEE, and PubMed were searched and the time period was between 2013 and 2022. Based on the review of similar articles, a five-point Likert scale checklist was developed in the second phase. The statistical population of the present study was specialist physicians (N = 40) and patients (N = 384). In order to analyze the data, SPSS Statistics 24 was used. To analyze the data obtained from the checklist, we used summary statistics (mean and standard deviation).

RESULTS

As a result of the review literature process, 50 papers were screened, that based we can distinguish motivational and inhibitory factors affecting the use of health information technology in hypertension management. Indeed, Motivational factors and inhibitory factors can be classified into five groups: organizational, economic, technical, personal, and legal/moral factors. Based on the results of the checklist, the factors that were identified as most influential on motivation and inhibitory patients and specialist physicians' to use of health information technology to manage and treat hypertension.

CONCLUSION

Utilizing technologies for hypertension, its management can be improved by identifying motivating and inhibiting factors. Our approach can improve the acceptability of these technologies, save costs, reduce long-term complications of hypertension, and improve patient quality of life.

Investigating the prevalence of and predictive and risk factors for pulmonary embolism in patients with COVID-19 in Nemazee Teaching Hospital

Background

Pulmonary thromboembolism (PTE) is a significant contributing factor to vascular diseases. This study aimed to determine the prevalence of pulmonary thromboembolism and its predisposing factors in patients with COVID-19.

Methods

This cross-sectional study included 284 patients with COVID-19 who were admitted to Nemazee Teaching Hospital (Shiraz, Iran) between June and August 2021. All patients were diagnosed with COVID-19 by a physician based on clinical symptoms or positive polymerase chain reaction (PCR) test results. The collected data included demographic data and laboratory findings. Data were analyzed using the SPSS software. P≤0.05 was considered statistically significant.

Results

There was a significant difference in the mean age between the PTE group and non-PTE group (P=0.037). Moreover, the PTE group had a significantly higher prevalence of hypertension (36.7% vs. 21.8%, P=0.019), myocardial infarction (4.5% vs. 0%, P=0.006), and stroke (23.9% vs. 4.9%, P=0.0001). Direct bilirubin (P=0.03) and albumin (P=0.04) levels significantly differed between the PTE and non-PTE groups. Notably, there was a significant difference in the partial thromboplastin time (P=0.04) between the PTE and non-PTE groups. A regression analysis indicated that age (OR, 1.02; 95% CI, 1.00‒1.004; P=0.005), blood pressure (OR, 2.07; 95% CI, 1.12‒3.85; P=0.02), heart attack (OR, 1.02; 95% CI, 1.28‒6.06; P=0.009), and albumin level (OR, 0.39; 95% CI, 0.16‒0.97; P=0.04) were all independent predictors of PTE development.

Conclusion

Regression analysis revealed that age, blood pressure, heart attack, and albumin levels were independent predictors of PTE.

Initiative to reduce inappropriate venous thromboembolism prophylaxis in an 11-hospital safety net system: An electronic health records-based approach

BACKGROUND

While pharmacologic prophylaxis has benefits for venous thromboembolism (VTE) prevention in high-risk patients, unnecessary use carries potential harm, including bleeding, heparin-induced thrombocytopenia, and patient discomfort, and should be avoided in low-risk patients. While many quality improvement initiatives aim to reduce underuse, successful models on reducing overuse are sparse in the literature.

OBJECTIVE

We aimed to create a quality improvement initiative to reduce overuse of pharmacologic VTE prophylaxis.

DESIGNS, SETTINGS AND PARTICIPANTS

A quality improvement initiative was implemented across 11 safety net hospitals in New York City.

INTERVENTION

The first electronic health record (EHR) intervention consisted of a VTE order panel that facilitated risk assessment and recommended VTE prophylaxis for high-risk patients only. The second EHR intervention used a best practice advisory that alerted clinicians when prophylaxis was ordered for a patient previously deemed "low risk." Prescribing rates were compared through a three-segment interrupted time series linear regression design.

RESULTS

Compared to the preintervention period, the first intervention did not change the rate of total pharmacologic prophylaxis immediately after implementation (1.7% relative change, p = .38) or over time (slope difference of 0.20 orders per 1000 patient days, p = .08). Compared to the first intervention period, the second intervention led to an immediate 4.5% reduction in total pharmacologic prophylaxis (p = .04) but increased thereafter (slope difference of 0.24, p = .03) such that weekly rates at the end of the study were similar to rates prior to the second intervention.