Administrative Memos

199908

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 14, 1999
SUBJECT: Deep Venous Thrombosis (DVT) Prophylaxis in New York State - An Impact Report
IPRO CONTACTS:

Charles Stimler, M.D., M.P.H., Clinical Coordinator - Ext. 410, Terri Straub, R.N., M.B.A., Senior Director, Improvement Strategies/QI - Ext. 410 and Marguerite Shaffer, R.N., Director Downstate, Improvement Strategies QI - Ext. 356

Enclosed please find a report entitled "Deep Venous Thrombosis Prophylaxis in New York State - An Impact Report". This report describes the final phase of a quality improvement study which began in 1995. At that time a baseline report was released that identified opportunities for improvement in providing better DVT prophylaxis for patients undergoing hip replacement surgery and prostatectomy. The release of this report was followed by the active participation of approximately 75 hospitals which furnished quality improvement plans (QIPs) focusing on the prevention of deep venous thrombosis (DVT) among their orthopedic and urological surgery cases. Interventions conducted by IPRO included educational meetings for hospital staff, conference calls with health care providers, feedback of QIP critiques to hospital quality departments, and widespread dissemination of study findings through publications and the world wide web.

This final impact report documents a very large and statistically significant increase in the use of effective DVT prophylaxis in prostatectomy cases, from 59.5% at baseline to 87.8% at impact measurement. This represents an absolute increase of 28.3%. There was also a large and statistically significant increase noted in the use of intermittent pneumatic compression (IPC) among both hip replacement surgery cases and prostatectomy cases, as well as a significant increase in the use of dextran among prostatectomy cases. Further details of all results are presented in the enclosed report.

Should you have any questions about IPRO's "Deep Venous Thrombosis Prophylaxis in New York State - An Impact Report" project or report, please feel free to contact Dr. Charles Stimler, Marguerite Shaffer, or Terri Straub.

EXECUTIVE SUMMARY

Deep venous thrombosis (DVT) can be a serious postoperative complication of high risk surgical procedures such as hip replacement surgery and radical prostatectomy. The impact of DVT prophylaxis on reducing postoperative morbidity and mortality in these settings has been demonstrated. Many choices of useful prophylactic regimens exist and appear effective in preventing DVT and its sometimes fatal sequel, pulmonary embolus. Among effective pharmacologic options are standard heparin, low molecular weight heparin (LMWH), dextran, and warfarin. Intermittent pneumatic compression (IPC) is an effective active mechanical method.

In October, 1995 IPRO sent to all hospitals in New York state a baseline report entitled "The Use of Deep Venous Thrombosis Prophylaxis in High Risk Surgical Cases". This report contained data estimating the prevailing rates of use of effective DVT prophylaxis among hip replacement cases (86%) and radical prostatectomy cases (59.5%). Opportunities for improvement were identified and numerous interventions were performed by IPRO to assist hospitals in their quality improvement efforts. Interventions included conference calls, educational meetings, grand round presentations, and direct collaboration with interested hospitals. Ninety-nine hospitals directly collaborated with IPRO, of which 75 submitted quality improvement plans (QIPs) and 60 fully implemented these plans.

Remeasurement of the quality indicators performed for the impact period of November 1, 1997 through April 30, 1998 revealed the following results:

A very large and statistically significant increase was noted in the use of effective DVT prophylaxis in prostatectomy cases, with an increase from 59.5% at baseline to 87.8% at impact measurement. This represents an absolute increase of 28.3%.
A large and statistically significant increase was noted in the use of IPC among prostatectomy cases (55.8% at baseline to 83.6% at impact measurement).
A large and statistically significant increase was noted in the use of IPC among hip replacement surgery cases (34.2% at baseline to 57.0% at impact measurement).
A smaller but statistically significant increase was noted in the use of dextran among prostatectomy cases (0.0% at baseline to 11.1% at impact measurement).
No significant changes in the use of effective DVT prophylaxis among hip replacement surgery cases were noted.

Most of the improvement noted in the quality indicator for prostatectomy was directly related to an increased utilization of IPC. Urologists have implemented many of IPRO's suggested interventions on a wide scale. This has resulted in an increased quality of care for Medicare patients undergoing this surgery.