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Targeted Quality Improvement Trial to Improve Post-Discharge VTE Chemoprophylaxis after Abdominal and Pelvic Cancer Surgery

Award Number: R01HL183429
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 06/15/2026
PERIOD OF PERFORMANCE END DATE: 05/31/2031

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Targeted Quality Improvement Trial to Improve Post-Discharge VTE Chemoprophylaxis after Abdominal and Pelvic Cancer Surgery - Venous thromboembolism (VTE), which includes both deep venous thrombosis (DVT) and pulmonary embolism (PE), is the most common preventable cause of mortality following major abdominal and pelvic cancer surgery. To date, most quality improvement initiatives have focused on improving inpatient VTE prophylaxis and detection, in part because of required measurement and significant financial incentives, and deterrents for hospitals by payers and policy makers. However, VTE risk extends beyond inpatient hospitalization. At least one-third of VTE complications occur after patients are discharged (post-discharge). Multiple randomized trials have repeatedly demonstrated that chemoprophylaxis extending beyond the inpatient hospital stay decreases the risk of VTE complications after abdominal and pelvic cancer surgery. Consequently, national guidelines recommend post-discharge VTE chemoprophylaxis. Nevertheless, significant variation and poor adoption of these guidelines persists. We previously found that a post- discharge prescription for VTE chemoprophylaxis was filled in less than 10% of patients and post-discharge VTE was one of the most common reasons for clinical deterioration. Together, these findings reveal an urgent need to improve adherence to post-discharge VTE chemoprophylaxis guidelines. Since 2016, in partnership with the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), our team, led by the PI, developed an implementation initiative to improve post-discharge VTE chemoprophylaxis in a multistate, hospital quality collaborative (Illiana Surgical Quality Improvement Collaborative [ISQIC]). ISQIC uses a multi-component quality improvement (QI) approach to improve surgical care. This approach led to a 15% increase in overall post-discharge VTE chemoprophylaxis adherence, however, at the hospital level, adherence was widely variable ranging from <10% to >90%. Therefore, our team seeks to advance the knowledge of implementing a complex intervention by systematically and comprehensively assessing VTE implementation strategies in low performing hospitals. We will then conduct a stepped wedge implementation trial in 16 hospitals to test a standard vs. targeted implementation strategy in low-performance hospitals. In Aim 1, we will identify the barriers and facilitators of a multicomponent post-discharge VTE Collaborative-wide Quality improvement Project (CQIP) intervention in current ISQIC hospitals. In Aim 2 we will identify both low- and high-performance hospital quality phenotypes and identify effective targeted implementation strategies. In Aim 3 we will conduct a Type III Hybrid trial to evaluate the effect of targeted implementation strategies to improve post-discharge VTE chemoprophylaxis adherence among intervention naïve ACS NSQIP hospitals. The new knowledge generated from this proposal will allow this team to expand implementation of QI interventions to directly improve the safety of surgery across the United States. 1


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $642,477 )
2026	2026	UNIVERSITY OF CHICAGO	5801 S ELLIS AVE	CHICAGO	IL	60637	COOK	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	6/23/2026	NEW	$642,477
														Subtotal = $642,477

Grand Total All Awards = $642,477

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Targeted Quality Improvement Trial to Improve Post-Discharge VTE Chemoprophylaxis after Abdominal and Pelvic Cancer Surgery

Award Number: R01HL183429

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 06/15/2026

PERIOD OF PERFORMANCE END DATE: 05/31/2031

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