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JCOM Abstract

J Clin Outcomes Manage 
2013 Oct;20(10):447-454
Impact of an educational intervention in a post-discharge VTE prophylaxis quality improvement initiative
Merwin SL, Ismail H, Kohn N, Chaudhry S, Rosenberg DJ

ABSTRACT Objective: To assess provider attitudes toward receiving an educational intervention using a human alert encouraging post-discharge VTE prophylaxis, to assess how new information was integrated into provider practice, and to determine if there were persistent effects. Methods: Medical inpatients awaiting discharge were screened to identify those at high risk of VTE who were not ordered to receive thromboprophylaxis after discharge. Eligible patients were randomized to “alert” or “no alert.” We contacted providers of patients in the alert group with the suggestion to continue thrombo-prophylaxis using a modified academic detailing approach, and we characterized provider attitudes towards receiving the alert. After the study was completed, we surveyed providers to assess potential effects of the alert intervention. Results: 120 provider alerts to 56 providers were studied. For the initial contact, provider responses to the alert were positive (64%), neutral (25%), dismissive (4%), and no response (7%). Across all encounters, differences were noted between specialties and provider type (p = 0.002). Survey responses for 42/56 (75%) providers were obtained, with 57% reporting learning something new and 27% reporting they had changed practice as a result of the alert. 82% said they would consider post-discharge VTE in the future. Conclusion: Our findings support that one size does not fit all when offering education to providers but suggest that academic detailing can be used successfully to stimulate critical thinking about new medical information. Provider characteristics, culture, and external factors should be considered when tailoring education efforts.

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