A Mixed-Methods Evaluation of a Collaborative-Wide Quality Improvement Project to Improve Postdischarge Venous Thromboembolism Chemoprophylaxis After Abdominopelvic Cancer Surgery
Year: 2025
Type: article
Abstract: Objective: We studied a collaborative-wide quality improvement project (CQIP) focused on improving postdischarge venous thromboembolism (VTE) chemoprophylaxis adherence. We aimed to identify patient-level characteristics associated with adherence, evaluate differences in adherence rates among participating hospitals, and assess facilitators and barriers to adherence at high- and low-performing hospitals. Background: VTE is the most common preventable cause of death after abdominopelvic cancer surgery, yet adherence to guideline-recommended postdischarge VTE chemoprophylaxis remains suboptimal. A CQIP including audit and feedback of performance data, a toolkit, coaching calls, and best practice alerts was implemented. Methods: Patients undergoing inpatient abdominopelvic cancer surgery at a CQIP-enrolled hospital during a 3-year study period were included. Unadjusted and adjusted rates were calculated for postdischarge VTE chemoprophylaxis adherence. High performance was defined as >10% improvement and/or ≥80% adherence. We conducted semistructured interviews and focus groups with collaborative members to identify barriers and facilitators to implementation. Results: < 0.05). Patients who underwent urologic (odds ratio [OR], 1.76 [95% CI, 1.27-2.43]) and gynecologic procedures (OR, 3.90 [95% CI, 2.73-5.58]) were more likely prescribed appropriate VTE chemoprophylaxis compared with colorectal procedures. Eight hospitals (50%) had improvement in adherence rates, and 8 (50%) were high performers. Barriers to implementation included a lack of surgeon buy-in, technical challenges, and a lack of awareness. Conclusions: A CQIP was associated with increased postdischarge VTE adherence rates. Different barriers exist between high- and low-performing hospitals. Future collaborative work should focus on hospital-level interventions to improve low-performer results.
Source: Annals of Surgery Open
Authors: Kimberly B. Golisch, Casey M. Silver, Ying Shan, Andres Guerra, Lauren M. Janczewski, Jeanette Chung, Brianna D’Orazio, Julie K. Johnson, Vivek N. Prachand, Michael F. McGee, David D. Odell, Anthony D. Yang, Karl Y. Bilimoria, Ryan P. Merkow, for the Illiana Surgical Quality Improvement Collaborative
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W4408128138