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Wendelboe A, Weitz JI. Global Health Burden of Venous Thromboembolism. Arterioscler Thromb Vasc Biol 2024; 44:1007-1011. [PMID: 38657032 DOI: 10.1161/atvbaha.124.320151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Aaron Wendelboe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City (A.W.)
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
- Department of Medicine (J.I.W.), McMaster University, Hamilton, Ontario, Canada
- Department of Biochemistry and Biomedical Sciences (J.I.W.), McMaster University, Hamilton, Ontario, Canada
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Peseski AM, Kapoor S, Kuchibhatla M, Adamski A, Abe K, Beckman MG, Reyes NL, Richardson LC, Saber I, Schulteis R, Singh BP, Sitlinger A, Thames EH, Ortel TL. An epidemiologic study comparing cancer- and noncancer-associated venous thromboembolism in a racially diverse Southeastern United States county. Res Pract Thromb Haemost 2024; 8:102420. [PMID: 38817950 PMCID: PMC11137544 DOI: 10.1016/j.rpth.2024.102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Background Cancer-associated venous thromboembolism (CA-VTE) represents a major cause of morbidity and mortality in patients with cancer. Despite poor outcomes, there is an ongoing knowledge gap in epidemiologic data related to this association. Objectives To compare venous thromboembolism (VTE) characteristics, risk factors, and outcomes between patients with and without active cancer in a racially diverse population. Methods Our surveillance project occurred at the 3 hospitals in Durham County, North Carolina, from April 2012 through March 2014. Electronic and manual methods were used to identify unique Durham County residents with VTE. Results We identified 987 patients with VTE during the surveillance period. Of these, 189 patients had active cancer at the time of their VTE event. Patients with CA-VTE were older (median age: 69 years vs 60 years, P < .0001) and had a lower body mass index (median body mass index: 26.0 kg/m2 vs 28.4 kg/m2, P = .0001) than noncancer patients. The most common cancers in our cohort were gastrointestinal, breast, genitourinary, and lung. The proportion of VTE cases with pulmonary embolism (PE) was greater in the cancer cohort compared with that in the noncancer cohort (58.2% vs 44.0%, P = .0004). Overall survival was lower in the CA-VTE group than in patients without cancer (P < .0001). Black patients with CA-VTE had lower proportion of PE (52.3% vs 67.1%, P = .05) but had decreased survival (P < .0003) in comparison with White patients. Conclusion Future studies may be needed to continue to evaluate local and national VTE data to improve VTE prevention strategies and CA-VTE outcomes.
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Affiliation(s)
- Andrew M. Peseski
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Sargam Kapoor
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Alys Adamski
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karon Abe
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michele G. Beckman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nimia L. Reyes
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ryan Schulteis
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Bhavana Pendurthi Singh
- Division of Hematology Oncology, Lehigh Valley Hospital Pocono, East Stroudsburg, Pennsylvania, USA
| | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina, USA
| | - Elizabeth H. Thames
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Thomas L. Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
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Khan S, King D, Osmani S, Harte O, Solomon J, Niranjan K, Rosenberg DJ. Provider Response to a Venous Thromboembolism Risk Assessment and Prophylaxis Ordering Tool: Observational Study. Appl Clin Inform 2022; 13:1214-1222. [PMID: 36577502 PMCID: PMC9797348 DOI: 10.1055/s-0042-1759770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/26/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Our health system launched an initiative to regulate venous thromboembolism (VTE) risk assessment and prophylaxis with electronically embedded risk assessment models based on validated clinical prediction rules. Prior to system-wide implementation, usability testing was conducted on the VTE clinical decision support system (CDSS) to assess provider perceptions, facilitate adoption, and usage of the tool. The objective of this study was to conduct usability testing with end users on the CDSS' risk assessment model and prophylaxis ordering components. METHODS This laboratory usability testing study was conducted with 24 health care providers. Participants were given two case scenarios that mirrored real-world scenarios to assess likelihood of use and adoption. During each case scenario, participants engaged in a think-aloud session, verbalizing their decision-making process while interacting with the tool. Following each case scenario, participants completed the System Usability Scale (SUS) and a posttask interview. Participants' comments and interactions with the VTE CDSS were placed into coding categories and analyzed for generalizable themes by three independent coders. RESULTS Of the 24 participants, 50% were female and the mean age of all participants was 32.76 years. The average SUS across the different services lines was 72.39 (C grade). Each participant's comments were grouped into three overarching themes: functionality, visibility/navigation, and content. Comments included personalizing workflow for each service line, minimizing the number of clicks, clearly defining risk models, including background on risk scores, and providing treatment guidelines for order sets. CONCLUSION An important step toward providing quality health care to patients at risk of developing a VTE event is providing user-friendly tools to providers. Following usability testing, our study revealed opportunities to positively impact provider behavior and acceptance. The rigor and breadth of this usability testing study and adoption of the optimizations should increase provider adoption and retention of the VTE CDSS.
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Affiliation(s)
- Sundas Khan
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
- Department of Medicine, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs (VA) Medical Center, Houston, Texas, United States
| | - D'Arcy King
- Department of Clinical Psychology, Fielding Graduate University, Santa Barbara, California, United States
| | - Soheb Osmani
- Department of Medicine, Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
| | - Owen Harte
- Department of Biological Sciences, College of Science, University of Notre Dame, Notre Dame, Indiana, United States
| | - Jeffrey Solomon
- Department of Medicine, Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
| | - Kunti Niranjan
- Department of Medicine, Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
| | - David J. Rosenberg
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
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Saber I, Adamski A, Kuchibhatla M, Abe K, Beckman M, Reyes N, Schulteis R, Pendurthi Singh B, Sitlinger A, Thames EH, Ortel TL. Racial differences in venous thromboembolism: A surveillance program in Durham County, North Carolina. Res Pract Thromb Haemost 2022; 6:e12769. [PMID: 35873215 PMCID: PMC9301530 DOI: 10.1002/rth2.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background Venous thromboembolism (VTE) affects approximately 1-2 individuals per 1000 annually and is associated with an increased risk for pulmonary hypertension, postthrombotic syndrome, and recurrent VTE. Objective To determine risk factors, incidence, treatments, and outcomes of VTE through a 2-year surveillance program initiated in Durham County, North Carolina (population approximately 280,000 at time of study). Patients/Methods We performed a retrospective analysis of data actively collected from three hospitals in Durham County during the surveillance period. Results A total of 987 patients were diagnosed with VTE, for an annual rate of 1.76 per 1000 individuals. Hospital-associated VTE occurred in 167 hospitalized patients (16.9%) and 271 outpatients who were hospitalized within 90 days of diagnosis (27.5%). Annual incidence was 1.98 per 1000 Black individuals compared to 1.25 per 1000 White individuals (p < 0.0001), and Black individuals with VTE were younger than White individuals (p < 0.0001). Common risk factors included active cancer, prolonged immobility, and obesity, and approximately half were still taking anticoagulant therapy 1 year later. A total of 224 patients died by 1 year (28.5% of patients for whom outcomes could be confirmed), and Black patients were more likely to have recurrent VTE than White patients during the first 6 months following initial presentation (9.4% vs. 4.1%, p = 0.01). Conclusions Ongoing surveillance provides an effective strategy to identify patients with VTE and monitor treatment and outcomes. We demonstrated that hospital-associated VTE continues to be a major contributor to the burden of VTE and confirmed the higher incidence of VTE in Black compared to White individuals.
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Affiliation(s)
- Ibrahim Saber
- Division of Hematology, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Alys Adamski
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNorth CarolinaUSA
| | - Karon Abe
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Nimia Reyes
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Ryan Schulteis
- Durham Veterans' Administration Medical CenterDurhamNorth CarolinaUSA
| | | | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Elizabeth H. Thames
- Division of Hematology, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Thomas L. Ortel
- Division of Hematology, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
- Department of PathologyDuke University Medical CenterDurhamNorth CarolinaUSA
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Wendelboe A, Saber I, Dvorak J, Adamski A, Feland N, Reyes N, Abe K, Ortel T, Raskob G. Exploring the Applicability of Using Natural Language Processing to Support Nationwide Venous Thromboembolism Surveillance: Model Evaluation Study. JMIR BIOINFORMATICS AND BIOTECHNOLOGY 2022; 3:e36877. [PMID: 37206160 PMCID: PMC10193259 DOI: 10.2196/36877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/13/2022] [Accepted: 07/21/2022] [Indexed: 05/21/2023]
Abstract
Background Venous thromboembolism (VTE) is a preventable, common vascular disease that has been estimated to affect up to 900,000 people per year. It has been associated with risk factors such as recent surgery, cancer, and hospitalization. VTE surveillance for patient management and safety can be improved via natural language processing (NLP). NLP tools have the ability to access electronic medical records, identify patients that meet the VTE case definition, and subsequently enter the relevant information into a database for hospital review. Objective We aimed to evaluate the performance of a VTE identification model of IDEAL-X (Information and Data Extraction Using Adaptive Learning; Emory University)-an NLP tool-in automatically classifying cases of VTE by "reading" unstructured text from diagnostic imaging records collected from 2012 to 2014. Methods After accessing imaging records from pilot surveillance systems for VTE from Duke University and the University of Oklahoma Health Sciences Center (OUHSC), we used a VTE identification model of IDEAL-X to classify cases of VTE that had previously been manually classified. Experts reviewed the technicians' comments in each record to determine if a VTE event occurred. The performance measures calculated (with 95% CIs) were accuracy, sensitivity, specificity, and positive and negative predictive values. Chi-square tests of homogeneity were conducted to evaluate differences in performance measures by site, using a significance level of .05. Results The VTE model of IDEAL-X "read" 1591 records from Duke University and 1487 records from the OUHSC, for a total of 3078 records. The combined performance measures were 93.7% accuracy (95% CI 93.7%-93.8%), 96.3% sensitivity (95% CI 96.2%-96.4%), 92% specificity (95% CI 91.9%-92%), an 89.1% positive predictive value (95% CI 89%-89.2%), and a 97.3% negative predictive value (95% CI 97.3%-97.4%). The sensitivity was higher at Duke University (97.9%, 95% CI 97.8%-98%) than at the OUHSC (93.3%, 95% CI 93.1%-93.4%; P<.001), but the specificity was higher at the OUHSC (95.9%, 95% CI 95.8%-96%) than at Duke University (86.5%, 95% CI 86.4%-86.7%; P<.001). Conclusions The VTE model of IDEAL-X accurately classified cases of VTE from the pilot surveillance systems of two separate health systems in Durham, North Carolina, and Oklahoma City, Oklahoma. NLP is a promising tool for the design and implementation of an automated, cost-effective national surveillance system for VTE. Conducting public health surveillance at a national scale is important for measuring disease burden and the impact of prevention measures. We recommend additional studies to identify how integrating IDEAL-X in a medical record system could further automate the surveillance process.
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Affiliation(s)
- Aaron Wendelboe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ibrahim Saber
- Division of Hematology, Department of Medicine, Duke University, Durham, NC, United States
| | - Justin Dvorak
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Alys Adamski
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Natalie Feland
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Nimia Reyes
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Karon Abe
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Thomas Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham, NC, United States
| | - Gary Raskob
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Shen C, Ge B, Liu X, Chen H, Qin Y, Shen H. Predicting the occurrence of venous thromboembolism: construction and verification of risk warning model. BMC Cardiovasc Disord 2020; 20:249. [PMID: 32460701 PMCID: PMC7251685 DOI: 10.1186/s12872-020-01519-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background The onset of venous thromboembolism is insidious and the prognosis is poor. In this study, we aimed to construct a VTE risk warning model and testified its clinical application value. Methods Preliminary construction of the VTE risk warning model was carried out according to the independent risk warning indicators of VTE screened by Logistic regression analysis. The truncated value of screening VTE was obtained and the model was evaluated. ROC curve analysis was used to compare the test of Caprini risk assessment scale and VTE risk warning model. The cut-off value of the VTE risk warning model was used to evaluate the test effectiveness of the model for VTE patients with validation data set. Results The VTE risk warning model is p = ex / (1+ ex), x = − 4.840 + 2.557 • X10(1) + 1.432 • X14(1) + 2.977 • X15(1) + 3.445 • X18(1) + 1.086 • X25(1) + 0.249 • X34 + 0.282 • X41. ROC curve results show that: AUC (95%CI), cutoff value, sensitivity, specificity, accuracy, Youden index, Caprini risk assessment scale is 0.596 (0.552, 0.638), 5, 26.07, 96.50, 61.3%, 0.226, VTE risk warning model is 0.960 (0.940, 0.976), 0.438, 92.61, 91.83, 92.2%, 0.844, respectively, with statistically significant differences (Z = 14.521, P < 0.0001). The accuracy and Youden index of VTE screening using VTE risk warning model were 81.8 and 62.5%, respectively. Conclusions VTE risk warning model had high accuracy in predicting VTE occurrence in hospitalized patients. Its test performance was better than Caprini risk assessment scale. It also had high test performance in external population.
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Affiliation(s)
- Chen Shen
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Binqian Ge
- School of Nursing, Suzhou Vocational Health College, 28 Kehua Road, Suzhou City, 215009, Jiangsu, China
| | - Xiaoqin Liu
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Hao Chen
- Department of Information, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Yi Qin
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China
| | - Hongwu Shen
- Department of Nursing, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong City, 226000, Jiangsu, China.
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Weingart SN, Yaghi O, Barnhart L, Kher S, Mazzullo J, Roberts K, Lominac E, Gittelson N, Argyris P, Harvey W. Preventing Diagnostic Errors in Ambulatory Care: An Electronic Notification Tool for Incomplete Radiology Tests. Appl Clin Inform 2020; 11:276-285. [PMID: 32294771 DOI: 10.1055/s-0040-1708530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Failure to complete recommended diagnostic tests may increase the risk of diagnostic errors. OBJECTIVES The aim of this study is to develop and evaluate an electronic monitoring tool that notifies the responsible clinician of incomplete imaging tests for their ambulatory patients. METHODS A results notification workflow engine was created at an academic medical center. It identified future appointments for imaging studies and notified the ordering physician of incomplete tests by secure email. To assess the impact of the intervention, the project team surveyed participating physicians and measured test completion rates within 90 days of the scheduled appointment. Analyses compared test completion rates among patients of intervention and usual care clinicians at baseline and follow-up. A multivariate logistic regression model was used to control for secular trends and differences between cohorts. RESULTS A total of 725 patients of 16 intervention physicians had 1,016 delayed imaging studies; 2,023 patients of 42 usual care clinicians had 2,697 delayed studies. In the first month, physicians indicated in 23/30 cases that they were unaware of the missed test prior to notification. The 90-day test completion rate was lower in the usual care than intervention group in the 6-month baseline period (18.8 vs. 22.1%, p = 0.119). During the 12-month follow-up period, there was a significant improvement favoring the intervention group (20.9 vs. 25.5%, p = 0.027). The change was driven by improved completion rates among patients referred for mammography (21.0 vs. 30.1%, p = 0.003). Multivariate analyses showed no significant impact of the intervention. CONCLUSION There was a temporal association between email alerts to physicians about missed imaging tests and improved test completion at 90 days, although baseline differences in intervention and usual care groups limited the ability to draw definitive conclusions. Research is needed to understand the potential benefits and limitations of missed test notifications to reduce the risk of delayed diagnoses, particularly in vulnerable patient populations.
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Affiliation(s)
- Saul N Weingart
- Tufts Medical Center, Boston, Massachusetts, United States.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Omar Yaghi
- Tufts Medical Center, Boston, Massachusetts, United States
| | - Liz Barnhart
- Tufts Medical Center, Boston, Massachusetts, United States
| | - Sucharita Kher
- Tufts Medical Center, Boston, Massachusetts, United States.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - John Mazzullo
- Tufts Medical Center, Boston, Massachusetts, United States
| | - Kari Roberts
- Tufts Medical Center, Boston, Massachusetts, United States.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Eric Lominac
- Tufts Medical Center, Boston, Massachusetts, United States
| | | | - Philip Argyris
- Tufts Medical Center, Boston, Massachusetts, United States
| | - William Harvey
- Tufts Medical Center, Boston, Massachusetts, United States.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States
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