Software systems boost blood clot prophylaxis

By David Douglas

NEW YORK (Reuters Health) - Pooled data indicate that computerized clinical decision support systems (CCDSS) can improve venous thromboembolism (VTE) prophylaxis and significantly reduce such events.

In a March 15 online paper in JAMA Surgery, Zachary M. Borab of New York University School of Medicine in New York City and colleagues report that CCDSS can be integrated into an electronic health record (EHR) and present evidence-based knowledge at an individual patient level.

For VTEs, clinician-level risk stratification has been shown to be inaccurate, the researchers say. To examine the additional utility of the CCDSS approach, they conducted a meta-analysis of data from 11 studies involving more than 156,000 participants.

Pooled data from 98,639 patients who received the CCDSS intervention and 50,175 controls revealed that CCDSS significantly increased the rate of ordering VTE prophylaxis (odds ratio, 2.35). It also prompted a significant decrease in the risk of VTE events (risk ratio, 0.78).

The findings are limited, the researchers point out, by the facts that most of the individual studies were not powered to detect a change in VTE events, and there was substantial heterogeneity between studies when the data were pooled.

Nevertheless, they conclude, "Use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events."

Commenting by email, Dr. Elliott R. Haut, co-author of an accompanying editorial, told Reuters Health, "This paper summarizes the strong evidence for effectiveness of CCDSS tools to improve VTE prevention. The evidence is overwhelming that CCDSS systems work."

Dr. Haut of Johns Hopkins University School of Medicine, Baltimore, Maryland, believes this kind of software should be more widely available. “EHR vendors should provide 'off the shelf' products that all their customers can use improve patient safety and quality of care,” he said. “Purchasers (i.e. hospitals) should have the option to simply turn on the option. For example, I would be willing to share our system for free with anyone who wants to use our approach. Unfortunately, it is not as simple as one may want."

The scope of CCDSS, he added, "could also be widened greatly. This paper looked only at VTE prevention. Although VTE is a critically important patient safety goal, there are dozens of other processes of care that CCDSS could improve. We have only scratched the surface of using technology to improve care."

Also commenting by email, Dr. Torben Bjerregaard Larsen of Aalborg University Hospital, Denmark, noted that CCDSSs have been used “in various settings to improve guideline adherence of perioperative procedures."

Dr. Larsen of the Aalborg Thrombosis Research Unit, added that the study "showed that use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events."

"If this approach can be transferred to your department," he concluded, "you should definitely consider using this simple technology wherever possible."

Borab did not respond to requests for comments.

SOURCE: http://bit.ly/2nPrB8g and http://bit.ly/2njW1Bz

JAMA Surg 2017.

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