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CC BY 4.0 · TH Open 2022; 06(01): e33-e39
DOI: 10.1055/s-0041-1742227
Original Article

Physicians' Views on Utilization of an Electronic Health Record–Embedded Calculator to Assess Risk for Venous Thromboembolism among Medical Inpatients: A Qualitative Study

Stephanie R. Moss 
1   Department of Hospital Medicine, Cleveland Clinic Community Care; Department of Pediatric Hospital Medicine, Pediatrics Institute; Cleveland Clinic, Cleveland, Ohio, United States
,
Kathryn A. Martinez
2   Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, United States
,
Cassandra Nathan
3   Brandeis University, Waltham, Massachusetts, United States
,
Elizabeth R. Pfoh
2   Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, United States
,
Michael B. Rothberg
2   Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, United States
› Institutsangaben Funding This study was funded by the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, grant no.: 1R01HS022883.
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Abstract

Background Venous thromboembolism (VTE) causes preventable in-hospital morbidity. Pharmacologic prophylaxis reduces VTE in at-risk patients but also increases bleeding. To increase appropriate prescribing, a risk calculator to guide prophylaxis decisions was developed. Despite efforts to promote its use, providers accessed it infrequently.

Objective This study aimed to understand provider perspectives on VTE prophylaxis and facilitators and barriers to using the risk calculator.

Design This is a qualitative study exploring provider perspectives on VTE prophylaxis and the VTE risk calculator.

Participants We interviewed attending physicians and advanced practice providers who used the calculator, and site champions who promoted calculator use. Providers were categorized by real-world usage over a 3-month period: low (<20% of the time), moderate (20–50%), or high (>50%).

Approach During semistructured interviews, we asked about experiences with VTE, calculator use, perspectives on its implementation, and experiences with other risk assessment tools. Once thematic saturation was reached, transcripts were analyzed using content analysis to identify themes.

Results Fourteen providers participated. Five were high utilizers, three were moderate utilizers, and six were low utilizers. Three site champions participated. Eight major themes were identified as follows: (1) ease of use, (2) perception of VTE risk, (3) harms of thromboprophylaxis, (4) overestimation of calculator use, (5) confidence in own ability, (6) underestimation of risk by calculator, (7) variability of trust in calculator, and (8) validation to withhold prophylaxis from low-risk patients.

Conclusions While providers found the calculator is easy to use, routine use may be hindered by distrust of its recommendations. Inaccurate perception of VTE and bleeding risk may prevent calculator use.

Keywords

venous thrombosis - deep vein thrombosis - prophylaxis - clinical decision support

Supplementary Material



Publikationsverlauf

Eingereicht: 03. August 2021

Angenommen: 29. November 2021

Artikel online veröffentlicht:
24. Januar 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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