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DOI: 10.1055/s-0041-1742227
Physicians' Views on Utilization of an Electronic Health Record–Embedded Calculator to Assess Risk for Venous Thromboembolism among Medical Inpatients: A Qualitative Study
Funding This study was funded by the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, grant no.: 1R01HS022883.
Abstract
Background Venous thromboembolism (VTE) causes preventable in-hospital morbidity. Pharmacologic prophylaxis reduces VTE in at-risk patients but also increases bleeding. To increase appropriate prescribing, a risk calculator to guide prophylaxis decisions was developed. Despite efforts to promote its use, providers accessed it infrequently.
Objective This study aimed to understand provider perspectives on VTE prophylaxis and facilitators and barriers to using the risk calculator.
Design This is a qualitative study exploring provider perspectives on VTE prophylaxis and the VTE risk calculator.
Participants We interviewed attending physicians and advanced practice providers who used the calculator, and site champions who promoted calculator use. Providers were categorized by real-world usage over a 3-month period: low (<20% of the time), moderate (20–50%), or high (>50%).
Approach During semistructured interviews, we asked about experiences with VTE, calculator use, perspectives on its implementation, and experiences with other risk assessment tools. Once thematic saturation was reached, transcripts were analyzed using content analysis to identify themes.
Results Fourteen providers participated. Five were high utilizers, three were moderate utilizers, and six were low utilizers. Three site champions participated. Eight major themes were identified as follows: (1) ease of use, (2) perception of VTE risk, (3) harms of thromboprophylaxis, (4) overestimation of calculator use, (5) confidence in own ability, (6) underestimation of risk by calculator, (7) variability of trust in calculator, and (8) validation to withhold prophylaxis from low-risk patients.
Conclusions While providers found the calculator is easy to use, routine use may be hindered by distrust of its recommendations. Inaccurate perception of VTE and bleeding risk may prevent calculator use.
Publication History
Received: 03 August 2021
Accepted: 29 November 2021
Article published online:
24 January 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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