Venous thromboembolism prevention program implementation in a community oncology practice: a cohort study

Area of Science:

• Oncology
• Hematology
• Implementation Science

Background:

• National guidelines advocate for Venous Thromboembolism (VTE) risk assessment in cancer outpatients.
• Pharmacologic prophylaxis is recommended for high-risk patients, yet adoption in community oncology is low.
• The Vermont Model (VM) is a proven guideline implementation strategy in academic settings.

Purpose of the Study:

• Adapt the Vermont Model (VM) for VTE risk assessment and prophylaxis to a community oncology practice setting.
• Implement the adapted VM across multiple community oncology sites.
• Evaluate the clinical and implementation outcomes of the adapted VM.

Main Methods:

• A multidisciplinary team adapted the VM, including electronic medical record (EMR) optimization and clinician education.
• The adapted VM was implemented, incorporating stakeholder feedback.
• Clinical and implementation outcomes were prospectively evaluated six months post-implementation.

Main Results:

• 302 cancer outpatients were included in the 6-month implementation period.
• VTE risk education reached 100% of patients, and 98% received risk assessment.
• Of high-risk patients (18%), 27% initiated prophylaxis; barriers included EMR issues, time, drug interactions, and financial concerns.

Conclusions:

• The multidisciplinary VTE prevention model successfully increased VTE education and risk assessment in community oncology.
• Anticoagulant prophylaxis rates increased modestly, underscoring the need to address prescribing barriers.
• Further strategies are needed to optimize VTE prophylaxis in community cancer care settings.