In a study reported in JCO Oncology Practice, Holmes et al found that a program instituted at the University of Vermont Medical Center was successful in improving venous thromboembolism (VTE) risk assessment, patient education, and rates of prophylaxis use in patients initiating anticancer treatment in an ambulatory cancer clinic.
As stated by the authors, “Guidelines recommend VTE risk assessment in outpatients with cancer and pharmacologic thromboprophylaxis in selected patients at high risk for VTE. Although validated risk-stratification tools are available, < 10% of oncologists use a risk assessment tool, and rates of VTE prophylaxis in high-risk patients are low in practice.”
Study Details
The program, entitled Venous Thromboembolism Prevention in the Ambulatory Cancer Clinic (VTEPACC), is an electronic health record (EHR)-based multidisciplinary program implemented by nurses, oncologists, pharmacists, hematologists, advanced practice providers, and quality partners. The aim of the program was to improve VTE patient education and risk assessment rates in patients initiating outpatient cancer chemotherapy and increase the percentage of high-risk patients receiving VTE prophylaxis.
In the program, high-risk patients were prospectively identified using Khorana and Protecht scores (≥ 3 points) using an EHR-based risk-assessment tool. Patients with a predicted high risk of VTE were offered a hematology consultation to discuss VTE prophylaxis.
Key Findings
A 1-year planning and preparation phase was followed by a 6-month implementation phase, with results reported for a total 2-year postimplementation phase. A total of 918 outpatients initiating anticancer therapy were evaluated in the program.
KEY POINTS
- Patient VTE monthly education rates increased from < 5% before VTEPACC to 81.6% during the implementation phase and to 94.7% for the full 2-year postimplementation phase.
- 93.4% of patients who were classified as high-risk attended the hematology consultation, and 93.8% of these patients received VTE prophylaxis.
Patient VTE monthly education rates increased from < 5% before VTEPACC to 81.6% during the implementation phase and to 94.7% for the full 2-year postimplementation phase.
In the postimplementation phase, 213 patients (23.2%) were identified as being at high risk for developing VTE. Among these, referrals to hematology were offered to 151 patients (70.8%); of these, 141 patients (93.4%) attended the hematology consultation and 93.8% of these patients received VTE prophylaxis.
The investigators concluded, “VTEPACC is a successful model for guideline implementation to provide VTE risk assessment and prophylaxis to prevent cancer-associated thrombosis in outpatients. Methods applied can readily translate into practice and overcome the current implementation gaps between guidelines and clinical practice.”
Chris E. Holmes, MD, PhD, of the Department of Medicine, Hematology and Oncology Division, University of Vermont, Burlington, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
