International Journal for Quality in Health Care 16:193-200 (2004)
International Journal for Quality in Health Care vol. 16 no. 3 © International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved
Uptake of new treatment strategies for deep vein thrombosis: an international audit
1 University of Lausanne, 3 University of Geneva, Switzerland, 2 Centre Hospitalier Universitaire de Grenoble, 4 Hôpital Européen Georges Pompidou, Paris, France, 5 Departments of Medicine and 6 Center for Health and Policy Studies, University of Calgary, Alberta, 7 University of Alberta, Edmonton, Alberta, Canada
Objective. Study of the uptake of new medical technologies provides useful information on the transfer of published evidence into usual practice. We conducted an audit of selected hospitals in three countries (Canada, France, and Switzerland) to identify clinical predictors of low-molecular-weight (LMW) heparin use and outpatient treatment, and to compare the pace of uptake of these new therapeutic approaches across hospitals.
Design. Historical review of medical records.
Setting and participants. We reviewed the medical records of 3043 patients diagnosed with deep vein thrombosis (DVT) in five Canadian, two French, and two Swiss teaching hospitals from 1994 to 1998.
Measures. We explored independent clinical variables associated with LMW heparin use and outpatient treatment, and determined crude and adjusted rates of LMW heparin use and outpatient treatment across hospitals.
Results. For the years studied, the overall rates of LMW heparin use and outpatient treatment in the study sample were 34.1 and 15.8%, respectively, with higher rates of use in later years. Many comorbidities were negatively associated with outpatient treatment, and risk-adjusted rates of use of these new approaches varied significantly across hospitals.
Conclusion. There has been a relatively rapid uptake of LMW heparins and outpatient treatment for DVT in their early years of availability, but the pace of uptake has varied considerably across hospitals and countries.
Keywords: anticoagulation, deep vein thrombosis, low-molecular-weight heparins, practice variation, process of care
Address reprint requests to Dr William Ghali, Faculty of Medicine, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1. E-mail: wghali{at}ucalgary.ca
Accepted for publication December 11, 2003.
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