Multi-Screen Electronic Alert for Venous Thromboembolism Prevention

Background and Significance:

Scope of the Problem: VTE is the third most common cardiovascular disease (heart attack and stroke are more common) but is the most preventable medical problem among patients hospitalized with other illnesses. DVT often causes chronic venous insufficiency, a potentially disabling and painful condition that lowers the quality of life. Acute PE may cause death or disabling chronic thromboembolic pulmonary hypertension. After discharge from a short-term hospital stay, one study reported that the incidence of DVT was 48 per 100,000 and the incidence of PE (with or without DVT) was 23 per 100,000.9 In addition, the incidence of VTE increases dramatically with age.10-11 Clinical manifestations of DVT often include swelling, pain, and extremity discoloration and may lead to PE. Manifestations of PE may include dyspnea, pleuritic pain, cough, and hemoptysis or may be asymptomatic.12-13 The 28-day mortality rate for a first VTE event is alarmingly high, approximately 11%.14 In addition, 3-month mortality rates for PE have been reported as high as 17%.15 However, appropriate prophylaxis-using anticoagulants, mechanical measures, or both anticoagulants plus mechanical measures-can prevent most episodes of VTE16. For example, mechanical measures as simple as "low tech" and inexpensive graduated compression stockings can reduce VTE rates.16a, 16b, 16c

Burden to Patients: VTE is associated with complications including recurrence of DVT or PE, chronic thromboembolic pulmonary hypertension, death, or the subsequent development of post-thrombotic syndrome. The risk of VTE recurrence is greatest within 6-12 months after the first event and continues for at least 10 years,17 and is a risk factor for death after PE.18 The post-thrombotic syndrome can have devastating effects on the patients' quality of life and is associated with venous hypertension that may cause pain, edema, skin changes, varicose veins, and skin ulcers. Valve dysfunction, which can lead to venous hypertension, is most often caused by a previous DVT.19 The cumulative incidence of the development of postthrombotic syndrome after a VTE event is high: 17% at one year, 23% at 2 years, and 29% at 8 years, with 30% of these cases classified as severe.20

Burden to Society: Direct medical costs to the United States health care system related to VTE events and complications approximate at least $600 million annually. Bullano and colleagues21 estimate that managed care plans pay a median of $3,131 per incident DVT, $6,424 per incident PE, and $12,200 for a DVT plus PE combination event. A 2004 registry of 5,451 patients with ultrasound-confirmed DVT at 183 institutions in the United States revealed that DVT led to hospitalization in 80% of those diagnosed as outpatients. Those initially diagnosed with DVT as inpatients remained hospitalized for a median of 12 days.7

Role of computerized healthcare delivery systems: