Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: Is there a differential effect by race?

BackgroundRacial disparities are common in healthcare. Venous thromboembolism (VTE) is a leading cause of preventable harm, and disparities observed in prevention practices. We examined the impact of a patient-centered VTE education bundle on the non-administration of preventive prophylaxis by race.MethodsA post-hoc, subset analysis (stratified by race) of a larger nonrandomized trial. Pre-post comparisons analysis were conducted on 16 inpatient units; study periods were October 2014 through March 2015 (baseline) and April through December 2015 (post-intervention). Patients on 4 intervention units received the patient-centered, nurse educator-led intervention if the electronic health record alerted a non-administered dose of VTE prophylaxis. Patients on 12 control units received no intervention. We compared the conditional odds of non-administered doses of VTE prophylaxis when patient refusal was a reason for non-administration, stratified by race.ResultsOf 272 patient interventions, 123 (45.2%) were white, 126 (46.3%) were black, and 23 (8.5%) were other races. A significant reduction was observed in the odds of non-administration of prophylaxis on intervention units compared to control units among patients who were black (OR 0.61; 95% CI, 0.46–0.81, ppp = 0.015).ConclusionOur finding suggests that the patient education materials, developed collaboratively with a diverse group of patients, improved patient’s understanding and the importance of VTE prevention through prophylaxis. Quality improvement interventions should examine any differential effects by patient characteristics to ensure disparities are addressed and all patients experience the same benefits.背景：医疗健康领域中种族差异现象较为普遍。静脉血栓栓塞症（Venous thromboembolism, VTE）是可预防性伤害的首要诱因，其临床预防实践中同样存在此类差异。本研究旨在评估以患者为中心的VTE教育包（patient-centered VTE education bundle）对不同种族患者未接受预防性给药情况的影响。 方法：本研究为一项大型非随机试验的事后亚组分析，按种族进行分层。研究纳入16个住院病房开展前后对照分析，研究周期分为两个阶段：2014年10月至2015年3月（基线期），以及2015年4月至2015年12月（干预后阶段）。其中4个干预病房的患者，若电子健康记录（electronic health record, EHR）提示存在未给药的VTE预防剂量，则会接受由护士教育者主导的以患者为中心的干预措施；12个对照病房的患者未接受任何干预。本研究按种族分层，对比了以患者拒绝作为未给药原因时，VTE预防给药未执行的条件比值比。 结果：本研究共纳入272例患者干预案例，其中123例（45.2%）为白人，126例（46.3%）为黑人，23例（8.5%）为其他种族。相较于对照病房，干预病房的黑人患者未接受预防性给药的比值比（odds ratio, OR）显著降低（OR=0.61；95%置信区间（confidence interval, CI）：0.46~0.81，Ppp=0.015）。 结论：本研究结果表明，与多样化患者群体协作开发的患者教育材料，可提升患者对VTE预防给药重要性的认知与理解。质量改进干预措施应根据患者特征评估其差异化效应，以确保种族差异得到解决，使所有患者均能获得同等收益。