Department of Medicine, Division of Hospital Medicine; Department of Population and Quantitative Health Sciences; Department of Emergency Medicine; Meyers Primary Care Institute
Cardiology | Cardiovascular Diseases | Emergency Medicine | Health Services Administration | Preventive Medicine
Preventing utilization of hospital and emergency department after diagnosis of venous thromboembolism is a complex problem. The objective of this study is to assess the impact of a care transition intervention on hospitalizations and emergency department visits after venous thromboembolism. We randomized adults diagnosed with a new episode of venous thromboembolism to usual care or a multicomponent intervention that included a home pharmacist visit in the week after randomization (typically occurring at time of discharge), illustrated medication instructions distributed during home visit, and a follow-up phone call with an anticoagulation expert scheduled for 8 to 30 days from time of randomization. Through physician chart review of the 90 days following randomization, we measured the incidence rate of hospital and emergency department visits for each group and their ratio. We also determined which visits were related to recurrent venous thromboembolism, bleeding, or anticoagulation and which where preventable. We enrolled 77 intervention and 85 control patients. The incidence rate was 4.50 versus 6.01 visits per 1000 patient days in the intervention versus control group (incidence rate ratio = 0.71; 95% confidence interval = 0.40-1.27). Most visits in the control group were not related to venous thromboembolism or bleeding (21%) and of those that were, most were not preventable (25%). The adjusted incidence rate ratio for the intervention was 1.05 (95% confidence interval = 0.57-1.91). Our patients had a significant number of hospital and emergency department visits after diagnosis. Most visits were not related to recurrent venous thromboembolism or bleeding and of those that were, most were not preventable. Our multicomponent intervention did not decrease hospitalizations and emergency department visits.
UMCCTS funding, anticoagulation, clinical pharmacy, home care services, patient education, preventative medicine
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DOI of Published Version
Kapoor A, Bloomstone S, Javed S, Silva M, Lynch A, Yogaratnam D, Carlone B, Springer K, Maheswaran A, Chen X, Nagy A, Elhag R, Markaddy E, Aungst T, Bartlett D, Houng D, Darling C, McManus D, Herzig SJ, Barton B, Mazor K. Reducing Hospitalizations and Emergency Department Visits in Patients With Venous Thromboembolism Using a Multicomponent Care Transition Intervention. Inquiry. 2020 Jan-Dec;57:46958019900080. doi: 10.1177/0046958019900080. PMID: 31965873; PMCID: PMC6977209. Link to article on publisher's site
Inquiry : a journal of medical care organization, provision and financing
Kapoor A, Bloomstone S, Javed S, Maheswaran A, Nagy A, Elhag R, Houng D, Darling CE, McManus DD, Barton BA, Mazor KM. (2020). Reducing Hospitalizations and Emergency Department Visits in Patients With Venous Thromboembolism Using a Multicomponent Care Transition Intervention. Open Access Articles. https://doi.org/10.1177/0046958019900080. Retrieved from https://escholarship.umassmed.edu/oapubs/4119
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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License