■住院期间和出院后的内科疾病患者的血栓预防仍未得到充分利用。临床决策支持(CDS)如果嵌入工作流程中,可以满足这一需求,在电子健康记录(EHR)之间可互换,并锚定在一个经过验证的模型上。
■本研究的目的是评估基于静脉血栓栓塞加D-二聚体静脉血栓栓塞模型的国际医学预防注册的通用EHR整合CDS工具的临床影响。
■这是一项从2020年12月21日至2022年1月21日对4家三级学术医院进行的整群随机试验。60岁以上有主要医疗疾病的住院患者符合资格。我们在入院和出院时嵌入了CDS。医院被随机分为干预组(CDS;n=2)和常规护理组(n=2)。主要结果是适当的血栓预防率。次要结果包括静脉,动脉,和总血栓栓塞,大出血,以及出院后30天的全因死亡率。
■排除后,对19,823例患者中的10,699例进行了分析。干预组工具采用率为77.8%。干预医院增加了适当的血栓预防,均为住院患者(80.1%vs72.5%,OR:1.52,95%CI:1.39-1.67)和出院时(13.6%vs7.5%,OR:1.93,95%CI:1.60-2.33)。静脉较少(2.7%vs3.3%,OR:0.80,95%CI:0.64-1.00),动脉(0.25%vs0.70%,OR:0.35,95%CI:0.19-0.67),和总血栓栓塞(2.9%vs4.0%,OR:0.71,95%CI:0.58-0.88)在干预医院。大出血很少见,组间没有差异。干预医院的死亡率更高(9.1%vs7.0%,OR:1.32,95%CI:1.15-1.53)。
■在内科住院患者中,嵌入EHR的CDS增加了适当的血栓预防并减少了血栓栓塞,而不增加大出血。干预医院的死亡率较高。
UNASSIGNED: Thromboprophylaxis for medically ill patients during hospitalization and postdischarge remains underutilized. Clinical decision support (CDS) may address this need if embedded within workflow, interchangeable among electronic health records (EHRs), and anchored on a validated model.
UNASSIGNED: The purpose of this
study was to assess the clinical impact of a universal EHR-integrated CDS tool based on the International Medical Prevention Registry on Venous Thromboembolism plus D-Dimer venous thromboembolism model.
UNASSIGNED: This was a cluster randomized
trial of 4 tertiary academic hospitals from December 21, 2020 to January 21, 2022. Inpatients over age 60 with key medical illnesses were eligible. We embedded CDS at admission and discharge. Hospitals were randomized to intervention (CDS; n = 2) vs usual care (n = 2) groups. The primary outcome was rate of appropriate
thromboprophylaxis. Secondary outcomes included venous, arterial, and total thromboembolism, major bleeding, and all-cause mortality through 30 days postdischarge.
UNASSIGNED: After exclusions, 10,699 of 19,823 patients were analyzed. Intervention group tool adoption was 77.8%. Appropriate
thromboprophylaxis was increased at intervention hospitals, both inpatient (80.1% vs 72.5%, OR: 1.52, 95% CI: 1.39-1.67) and at discharge (13.6% vs 7.5%, OR: 1.93, 95% CI: 1.60-2.33). There were fewer venous (2.7% vs 3.3%, OR: 0.80, 95% CI: 0.64-1.00), arterial (0.25% vs 0.70%, OR: 0.35, 95% CI: 0.19-0.67), and total thromboembolisms (2.9% vs 4.0%, OR: 0.71, 95% CI: 0.58-0.88) at intervention hospitals. Major bleeding was rare and did not differ between groups. Mortality was higher at intervention hospitals (9.1% vs 7.0%, OR: 1.32, 95% CI: 1.15-1.53).
UNASSIGNED: EHR-embedded CDS increased appropriate thromboprophylaxis and reduced thromboembolism without increasing major bleeding in medically ill inpatients. Mortality was higher at intervention hospitals.