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Disseminating a Patient Centered Venous Thromboembolism Prevention Bundle

Award Number: R18HS027415
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)
PERIOD OF PERFORMANCE START DATE: 03/01/2020
PERIOD OF PERFORMANCE END DATE: 02/28/2026

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Disseminating a Patient Centered Venous Thromboembolism Prevention Bundle - Summary Venous thromboembolism (VTE) has been called the single leading cause of preventable harm in hospitalized patients by AHRQ. Numerous studies have focused on improving prescription of VTE prophylaxis medication for hospitalized patients; however, prescription does not ensure administration. We found that VTE prophylaxis medication nonadherence among hospitalize patients is highly prevalent; on some floors patients miss only 5% of doses and on others nearly 40%. The most frequently documented reason for non- administration is patient refusal. Among patients with preventable VTE (defined as VTE in patients not receiving prophylaxis), the majority (72%) were prescribed optimal prophylaxis but missed one or more doses. Classically, interventions targeting medication nonadherence have been focused exclusively on outpatient settings, limiting their generalizability to hospitalized patients. In 2013, we were funded by the Patient Centered Outcomes Research Institute (PCORI) to develop and deliver a patient-centered, evidence-based intervention bundle in real-time using transactional electronic health record data to improve adherence to prescribed VTE prophylaxis for hospitalized patients. The goal of this intervention was to empower patients to make informed decisions about their VTE preventive care and improve VTE prophylaxis medication adherence in hospitalized patients in heterogeneous environments. Our research study showed significant improvement, with a 40% decline of nonadministration of pharmacologic VTE prophylaxis doses, and a 50% reduction in patient refusal. We further tested this intervention in a real-world setting where charge nurses on 8 different floors were given the patient education bundle to deliver; nonadherence decreased 47% and patient refusal decreased by 57%. We will scale up our intervention across diverse hospital settings, including a major academic medical centers and two community hospitals. Between these hospitals, VTE medication nonadherence ranges from 8.8% to 17.8%. We will deliver interactive, online, scenario-based education to frontline nurses regarding the importance of VTE prevention for hospitalized patients and will engage hospitalized patients who are at highest risk of VTE prophylaxis medication nonadherence using a patient-centered education intervention bundle. Our primary outcome is the proportion of administered VTE prophylaxis medication doses. Our secondary outcomes include the incidence of patient refusal for VTE prophylaxis medication, incidence of hospital- associated VTE using the validated AHRQ Patient Safety Indicator-12, and the proportion of patients with VTE who miss doses of prescribed prophylaxis. Successful completion of the proposed research will empower patients to make informed decisions about their VTE preventive care, increase VTE prophylaxis medication adherence, and improve delivery of patient- centered, defect-free VTE prevention to hospitalized patients across heterogeneous clinical settings.


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: 2025 ( Subtotal = $0 )
2025	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	5	2/6/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $379,952 )
2024	2024	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	001	5	2/28/2024	NON-COMPETING CONTINUATION	$379,952
2024	2023	THE JOHNS HOPKINS UNIVERSITY	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	2/28/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $379,952

Issue Date FY: 2023 ( Subtotal = $389,267 )
2023	2023	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	4	2/23/2023	NON-COMPETING CONTINUATION	$389,267
														Subtotal = $389,267

Issue Date FY: 2022 ( Subtotal = $400,000 )
2022	2022	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	2/18/2022	NON-COMPETING CONTINUATION	$400,000
														Subtotal = $400,000

Issue Date FY: 2021 ( Subtotal = $399,950 )
2021	2021	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	2/16/2021	NON-COMPETING CONTINUATION	$399,950
														Subtotal = $399,950

Issue Date FY: 2020 ( Subtotal = $400,000 )
2020	2020	JOHNS HOPKINS UNIVERSITY, THE	3400 N CHARLES ST	BALTIMORE	MD	21218	BALTIMORE CITY	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	2/17/2020	NEW	$400,000
														Subtotal = $400,000

Grand Total All Awards = $1,969,169

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Disseminating a Patient Centered Venous Thromboembolism Prevention Bundle

Award Number: R18HS027415

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

PERIOD OF PERFORMANCE START DATE: 03/01/2020

PERIOD OF PERFORMANCE END DATE: 02/28/2026

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