Thrombosis and Bleeding Risk Assessment in Medical Inpatients

住院患者的血栓形成和出血风险评估

基本信息

批准号：
9927665
负责人：
Neil Adrian Zakai
金额：
$ 68.05万
依托单位：
UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-15 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9927665
关键词：
Admission activity American Anticoagulants Benefits and Risks Biometry Cessation of life Clinical Cohort Studies Complex Complication Consumption Data Devices Dose Electronic Health Record Enoxaparin Epidemiology Event Failure Frequencies General Population Geography Goals Healthcare Healthcare Systems Hemorrhage Hospitalization Hospitals Incidence Incidence Study Inpatients Institution Intrinsic factor Measures Medical Medical Errors Methods Minnesota Modeling Outcome Patients Performance Pharmaceutical Preparations Pharmacology Physicians Population Population Heterogeneity Prevention Prevention Measures Prevention strategy Preventive treatment Professional Organizations Prophylactic treatment Provider Publishing Recording of previous events Reproducibility Research Research Infrastructure Research Personnel Risk Risk Assessment Risk Factors Rural Site Surgeon Thrombosis Time Translations United States Universities Validation Venous Thrombosis Vermont Washington Work clinical practice demographics electronic structure high risk innovation patient population pressure prevent prophylactic prospective recruit screening socioeconomics standard of care structured data venous thromboembolism

Admission activity American Anticoagulants Benefits and Risks Biometry Cessation of life Clinical Cohort Studies Complex Complication Consumption Data Devices Dose Electronic Health Record Enoxaparin Epidemiology Event Failure Frequencies General Population Geography Goals Healthcare Healthcare Systems Hemorrhage Hospitalization Hospitals Incidence Incidence Study Inpatients Institution Intrinsic factor Measures Medical Medical Errors Methods Minnesota Modeling Outcome Patients Performance Pharmaceutical Preparations Pharmacology Physicians Population Population Heterogeneity Prevention Prevention Measures Prevention strategy Preventive treatment Professional Organizations Prophylactic treatment Provider Publishing Recording of previous events Reproducibility Research Research Infrastructure Research Personnel Risk Risk Assessment Risk Factors Rural Site Surgeon Thrombosis Time Translations United States Universities Validation Venous Thrombosis Vermont Washington Work clinical practice demographics electronic structure high risk innovation patient population pressure prevent prophylactic prospective recruit screening socioeconomics standard of care structured data venous thromboembolism

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项目摘要

SUMMARY Each year, there are over 10 million non-surgical hospitalizations in the United States which trigger approximately 1 in 3 venous thromboembolism (VTE) events – or about 200,000 VTEs per year. National quality measures and professional societies recommend assessing VTE risk at admission and provide appropriate VTE prevention measures which include ambulation, sequential compression devices, and/or prophylactic dose anticoagulant medications (i.e. enoxaparin). In addition to reducing VTE, pharmacologic VTE prophylaxis also increases bleeding risk. Over the past few years there have been divergent pressures on clinicians regarding VTE prevention; on the one hand physicians are encouraged to assess VTE risk in non- surgical patients and provide VTE prophylaxis, and on the other a growing body of evidence suggests that the benefits of deceases in VTE may be outweighed by increased bleeding. Prior research of hospital-acquired (HA) VTE and bleeding has been hampered by the fact that it is a rare complication of a common event (hospitalization). Tens of thousands of hospitalizations need to be evaluated to obtain sufficient numbers of events to characterize who suffers HA-VTE and HA-bleeding. Prior studies have had to rely on time-consuming chart abstraction of thousands of hospitalizations or rely only on administrative data to study HA-VTE or HA- bleeding. With the introduction of the electronic health record, we can now assess tens of thousands of non- surgical admissions and determine who is at risk for VTE and bleeding. The aims of this proposal are threefold, at two diverse institutions (The University of Vermont and the University of Washington): (i) to develop risk models for HA-VTE and HA-bleeding (ii) to validate risk models for HA-VTE and HA-bleeding, and (iii) to determine the incidence of and risk factors for post-discharge VTE and bleeding. With these aims, we will make healthcare safer by allowing providers to tailor VTE prevention strategies to those at highest risk of VTE and lowest risk of bleeding. Our innovation lies in leveraging the potential of the electronic health record to efficiently study HA-VTE and HA-bleeding events in over 140,000 admissions, and in advancing clinical practice by developing validated risk models to allow providers to efficiently and rationally determine the risk:benefit of pharmacologic VTE prophylaxis at the time of admission and begin to understand the VTE and bleeding risks at discharge.

概括每年，美国都有超过1000万个非手术住院治疗大约三分之一的静脉血栓栓塞（VTE）事件，约为每年约200,000 VTE。国家的质量措施和专业社会建议在入场时评估VTE风险并提供适当的VTE预防措施，其中包括移动，顺序压缩装置和/或预防性剂量抗凝药物（即依诺氏蛋白酶）。除了减少VTE，药理学VTE 预防还增加出血风险。在过去的几年中，有不同的压力关于预防VTE的临床医生；一方面，鼓励医生评估非 - 手术患者并提供VTE预防，另一方面，越来越多的证据表明在VTE中脱离的好处可能会因出血的增加而超过。先前研究医院的经验（HA）VTE和出血受到了以下事实的障碍（住院）。需要评估成千上万的住院治疗以获得足够的数量表征谁遭受Ha-Vte和Ha-ha-bleeding的事件。先前的研究必须依靠时间耗时将数千次住院的抽象图表抽象，或仅依靠行政数据来研究HA-VTE或HA- 流血。随着电子健康记录的引入，我们现在可以评估成千上万的非 - 手术入院并确定谁有VTE和出血风险。该提议的目的是三倍，在两个潜水员机构（佛蒙特大学和华盛顿大学）：（i）发展风险 HA-VTE和HA-BUBLEDEDING（II）的模型，以验证HA-VTE和HA-Bleeding的风险模型，以及（iii）确定病后VTE和出血的危险因素和危险因素的事件。有了这些目标，我们将通过允许提供者对VTE风险最高的人量身定制VTE策略来使医疗保健更安全和最低的出血风险。我们的创新在于利用电子健康记录的潜力有效研究超过140,000次入院的HA-VTE和HA-BUPLEDED EVENT，并在临床上进行通过开发经过验证的风险模型的练习，以使提供商有效和合理地确定风险：入院时药理学VTE预防的好处，并开始理解VTE和出院时出血风险。