vte 3.0 final presentation

UPMC VTE Project 3.0 FINAL PRESENTATION

2015

CHRIS KOWALSKY

FACULTY ADVISOR

ANKUR TYAGI SRIKANTH GURUJU DHRUVIKA KOHLI

PROJECT MANAGER TECHNICAL ARCHITECT QUALITY ASSURANCE MANAGER

THE TEAM MAKING IT HAPPENMITHUN MATHEW

RISK & DOCUMENTATION MANAGER

YUCHEN ZHANG

FINANCIAL MANAGERPROJECT LIAISON

SUE SKLEDAR

UPMC/PITTPHARMACY ADVISOR

ROY SMITH DAWN SALERNO JAMES WAGNER

UPMC PHYSICIAN CONTENT EXPERT

DATA ANALYTICS TEAM DATA ANALYTICS TEAM

COLLEEN CULLEY

UPMC/PITT PHARMACY SPECIALIST

ANNE DOCIMO

UPMC PHYSICIAN ADMINISTRATIVE LEAD

2UPMC VTE 3.0

A

B

C

DBACKGROUND OF PROJECT

PROJECT SCOPE AND OBJECTIVES

DATA OVERVIEW

BLEED ANALYSIS

E

F

CLOT ANALYSIS

TAKE-AWAY

3

AGENDA

UPMC VTE 3.0

BACKGROUND OF PROJECTo Patient population: elective Total Hip and Total Knee Arthroplasty (THA/TKA) surgeries at UPMC from 2012-2014

o When a blood clot occurs, breaks loose or travels in the blood, this is called Venous Thromboembolism (VTE) - Affects patients who underwent orthopedic surgery, due to stasis of blood

o VTE may occur after TKA/THA if the patient is non-ambulatory for a prolonged period due to stasis of blood - they are put on a prophylactic regimen as a preventive measure

o The prophylactic regimen may lead to bleeding

4UPMC VTE 3.0

Determining the true rate of bleed and clot on 2012-2014 patient surgery data.

Performing comparative analysis of bleed/clot vs non-bleed/non clotpopulation on the basis of demographics, physical therapy,and patient risk for bleeding orclot as defined by the HAS-BLEDand CHADS2 scoring mechanism

.

Performing a comparative analysison the effectiveness andsafety of different prophylactic anticoagulant agents used for VTE

BLEED & CLOT RATE COMPARATIVE ANALYSIS PROPHYLACTIC ANTICOAGULANT AGENTS

PROJECT SCOPE

5UPMC VTE 3.0

01. REVAMPED CRITERIARefine and run VTE 2.0 clot and bleed criteria on 2012-2014 data

03. COMMON CHARACTERISTICSIdentify the common characteristics amongst patients who bled or clotted

02. RISK SCORESAssign CHADS2 and HAS-BLED to all the patients after completion of labeling

04. ANTICOAGULANTSDetermine which anticoagulant is least associated with postoperative clotting and bleeding in this dataset

OBJECTIVES

6UPMC VTE 3.0

DATA OVERVIEWVTE 3.0

COMPARATIVE ANALYSIS COUNT OF PATIENTS

PROJECT ITERATION THA TKA TOTAL

VTE 1.0 3156 5017 8173

VTE 2.0 5617 9108 14725

VTE 3.0 6367 9976 16343*

* 226 patients are common to both THA and TKA

8UPMC VTE 3.0

Num

ber o

f Pat

ient

s

0

1500

3000

4500

6000

HospitalsSMH SHY PUH PAS NWH MWH MER MCH HMC EAS BMC CHP

156

9301,286

278

1,040

3,306

399

2,297

62

5,232

3,161

037

509702

245

824

2,333

265

1,743

32

3,815

2,533

037310413

140490

1468

167

1042

26

2521

1489

VTE 1.0 VTE 2.0 VTE 3.0

COMPARATIVE ANALYSISPATIENT DISTRIBUTION BY HOSPITAL

9UPMC VTE 3.0

VTE 3.0 DATA

Male 2894(45%)

Female 3473(55%)

THA Male 3781(38%)

Female 6197(62%)

TKA

GENDER DISTRIBUTION

10UPMC VTE 3.0

BLEED ANALYSISVTE 3.0

COMPARATIVE ANALYSIS CRITERIABLEED CRITERIA VTE 1.0

CRITERIA DESCRIPTION SOURCE FILE LABEL STATUS

VTE Prophylaxis Reversal Agents

KCentra (PCC), rVIIa (NovoSeven), Vitamin K (Phytonadione) Charges Definite Label

Packed Red Blood Cells Receive >= 2 units, not including the day of surgery Charges Definite Label

Bleeding Readmission 58 diagnosis codes Diagnoses Definite Label

Hemoglobin Drop Drop in hemoglobin >= 2 units in 48 hours after the surgery Labs Definite Label

Bleeding Keywords EMR: Discharge Summary Potential Label, referenced with manual examination of the EMR text

Bleeding Procedures 4 Procedure Codes Procedures Potential Label, referenced with bleeding keywords

12UPMC VTE 3.0



A Packed Red Blood Cells Receive >= 1 units, after 2 days of surgery Charges Definite Label

B Bleeding related Diagnosis Code during Hospital Stay 50 diagnosis codes Diagnoses Definite Label

C Hemoglobin Drop Drop in hemoglobin >= 2 units in 48 hours after the surgery EMR Definite Label

D Bleeding Procedures One Procedure Code: 99.04 Procedures Definite Label

Final Criteria:A patient has satisfied either Criteria A or C

AND has satisfied Criteria B or D

13UPMC VTE 3.0



A Packed Red Blood Cells Receive >= 2 units, after the Hgb drop date till 15 days after surgery Charges Definite Label

B Bleeding related Diagnosis Code during Hospital Stay 51 diagnosis codes Diagnoses Definite Label

C Hemoglobin Drop Drop in hemoglobin >= 2 units, between a window of 2 days to 15 days after surgery EMR Definite Label

D Bleeding Procedures One Procedure Code: 99.04 Procedures Definite Label

‘All’ Bleed Criteria:A patient has satisfied either Criteria A or C

AND has satisfied Criteria B or D

14UPMC VTE 3.0

VTE 3.0BLEED ANALYSIS FLOWCHART

BLEED RESULT

CRITERIA

MASTER

CHARGE CODESFILTER

DIAGNOSIS CODESFILTER

PROCEDURE CODESFILTER

HGB DROP

PRE-MEDS INFO

DEMOGRAPHICS

DIAGNOSES

CHARGES

PROCEDURES

EMR

H&P

RAW DATA DATA CLEANING ANALYSIS

15UPMC VTE 3.0

B

D

A

C

A list of 51 diagnosis codes suggested by UPMC which are relevant to identifying bleed patients

One procedure code: 99.04 Packed Cell Transfusion

A list of 13 charge codes including Red Blood Cell (RBC) transfusion and fresh frozen plasma (FFP) related codes

The drop in hemoglobin (HGB) after surgery

‘ALL’ BLEEDVTE 3.0BLEED CRITERIA

AND

A. CHARGE CODES

OR

C. HGB DROP

B. DIAGNOSIS CODES

D. PROCEDURE CODE

OR

16UPMC VTE 3.0

MAJOR BLEEDIn addition to ‘All’ Bleed criteria, ensure that the patient was administered RBC and/or FFP ONLY after the HGB drop

VTE 3.0 BLEED CRITERIA

ALL BLEED CRITERIA

MAJOR BLEED

TRANSFUSION OCCURS AFTER

HGB DROPAND

UPMC VTE 3.017

‘ALL’ BLEED WINDOW MAJOR BLEED WINDOW

MAJOR BLEEDIn addition to ‘All’ Bleed criteria, ensure that the patient was administered RBC and/or FFP ONLY after the HGB drop

VTE 3.0 BLEED CRITERIA

ALL BLEED CRITERIA

MAJOR BLEED

TRANSFUSION OCCURS AFTER

HGB DROPAND

POST-OP ANEMIAIn addition to ‘All’ Bleed criteria, ensure that the diagnosis code 285.1 is associated with the patient.

ALL BLEED CRITERIA

POST-OP ANEMIA

DIAGNOSIS CODE 285.1AND

MINOR BLEEDThe rest of the patients identified by ‘All’ Bleed criteria who do not belong to Major Bleed or Minor Bleed criteria.

ALL BLEED CRITERIA

MINOR BLEED

NOT MAJOR BLEEDAND NOT POST-OP

ANEMIAAND

UPMC VTE 3.018

COMPARATIVE ANALYSIS RESULTS

PROJECT ITERATION TOTAL PATIENTS BLEED BLEED % OVER IDENTIFICATION %

VTE 1.0 8173 981 12% 780.00%

VTE 2.0 8772 463 5.28% 83.70%

VTE 3.0 16343 616 3.77% 28.69%


19UPMC VTE 3.0

VTE 3.0 DATA

No - Bleed 6136(96.37%)

Bleed 231(3.63%)

THA No - Bleed 9591(96.14%)

Bleed 385(3.86%)

TKA

‘ALL’ BLEED DISTRIBUTION

20UPMC VTE 3.0

Overall Bleed Percentage: 3.77%

* Patient data from 2012 - 2014* 226 patients are common to both THA and TKA

VTE 3.0 DATA

TYPE OF BLEED MAJOR BLEED MINOR BLEED POST-OP ANEMIA

THA 8 35 195

TKA 20 63 318

TYPE OF BLEED


21UPMC VTE 3.0

VTE 3.0 DATA

CONFUSION PREDICTEDMATRIX No - Bleed Bleed

ACTUALNo - Bleed 233 61

Bleed 16 11

THA BLEED CONFUSION MATRIX

22UPMC VTE 3.0

CONFUSION PREDICTEDMATRIX No - Bleed Bleed

ACTUALNo - Bleed 130 110

Bleed 9 26

TKA BLEED CONFUSION MATRIX


* ACTUAL: The data labeled by chart review* PREDICTED: The data labeled by VTE 3.0 criteria

Num

ber o

f Ble

ed P

atie

nts

0

20

40

60

80

% o

f Pat

ient

s w

ho B

led

0.00%

3.00%

6.00%

9.00%

12.00%

HospitalsCHP MCH BMC PUH NWH MWH PAS EAS MER HMC SMH SHY

VTE 3.0 DATADISTRIBUTION BY HOSPITAL - ‘ALL’ BLEED THA

‘All’ Bleed 0 1 2 3 5 7 22 26 29 30 51 72

No Bleed 1 61 16 35 163 1227 680 254 284 392 899 2323

Bleed% 0.00% 1.61% 11.11% 7.89% 2.98% 0.57% 3.93% 9.29% 9.27% 7.11% 5.37% 3.01%

23UPMC VTE 3.0

Num

ber o

f Ble

ed P

atie

nts

0

45

90

135

180

% o

f Pat

ient

s w

ho B

led

0.00%

7.50%

15.00%

22.50%

30.00%

HospitalsBMC PUH NWH MWH MCH EAS PAS SHY MER HMC SMH

VTE 3.0 DATADISTRIBUTION BY HOSPITAL - ‘ALL’ BLEED TKA

‘All’ Bleed 2 5 6 9 9 21 36 46 56 70 163

No Bleed 35 12 202 1820 191 577 1444 2483 601 715 1897

Bleed% 5.41% 29.41% 2.88% 0.49% 4.5% 3.51% 2.43% 1.82% 8.52% 8.92% 7.91%

24UPMC VTE 3.0

VTE 3.0 DATA

MER 1/657

PAS 2/1480

SHY 2/2529

SMH 18/2060

MAJOR BLEED COUNTS BY HOSPITAL

MER 1/313

MWH 1/1234

SHY 3/2395

SMH 3/950

THATKA

25UPMC VTE 3.0

VTE 3.0 DATA%

of B

leed

0

4

7

11

14

Combination of Medications

1 2 3 4 5 6 7 8

THATKA

MEDICATIONS PRIOR TO SURGERY (FROM H&P FILE) - ‘ALL’ BLEED

1 ASPIRIN, ENOXAPARIN, WARFARIN, DABIGATRAN 5 ASPIRIN, HEPARIN, ENOXAPARIN2 HEPARIN, ENOXAPARIN 6 ENOXAPARIN, WARFARIN3 ASPIRIN, HEPARIN, WARFARIN 7 ASPIRIN, ENOXAPARIN, WARFARIN4 HEPARIN, WARFARIN 8 ASPIRIN, HEPARIN

26UPMC VTE 3.0

UPMC VTE 3.0

VTE 3.0 DATA

Num

ber o

f Ble

ed P

atie

nts

0

35

70

105

140

% o

f Pat

ient

s w

ho B

led

0.00%

2.00%

4.00%

6.00%

8.00%

A B C D E F G H

POST-OPERATIVE MEDICATIONS vs ‘ALL’ BLEED RATIO - THA

A ASPIRIN 81MG TAB

27

‘All’ Bleed 34 42 115 139 24 17 13 0

No Bleed 410 640 1772 2148 1165 1410 2148 2

Bleed% 7.66 6.16 6.09 6.08 2.02 1.19 0.6 0

Post-Operative Medications

B FONDAPARINUX 2.5MG INJ

C WARFARIN

D ENOXAPARIN

E ASPIRIN 325 MGTAB

F RIVAROXABAN 10MG TAB

G HEPARIN 5000 UNITS/ML

H APIXABAN 2.5MG TAB

UPMC VTE 3.0

VTE 3.0 DATA

Num

ber o

f Ble

ed P

atie

nts

0

75

150

225

300

% o

f Pat

ient

s w

ho B

led

0.00%

5.00%

10.00%

15.00%

20.00%

A B C D E F G H

POST-OPERATIVE MEDICATIONS vs ‘ALL’ BLEED RATIO - TKA

A HEPARIN 5000 UNITS/ML

28

‘All’ Bleed 14 278 252 43 44 49 60 0

No Bleed 59 3655 3729 688 1037 1188 2539 3

Bleed% 19.18 7.07 6.33 5.88 4.07 3.96 2.31 0


B WARFARIN

C ENOXAPARIN

D APIXABAN 81MG TAB

E ASPIRIN 325 MG TAB

F FONDAPARINUX 2.5MG INJ

G RIVAROXABAN 10MG TAB


VTE 3.0 DATADISTRIBUTION OF POST-OPERATIVE MEDICATIONS BY HOSPITAL - MAJOR BLEED THA

29UPMC VTE 3.0

VTE 3.0 DATADISTRIBUTION OF POST-OPERATIVE MEDICATIONS BY HOSPITAL - MAJOR BLEED TKA

30UPMC VTE 3.0

Aver

age

Leng

th o

f Sta

y (In

day

s)

0

1

2

3

4

5

6

7

HospitalBMC CHP EAS HMC MCH MER MWH NWH PAS PUH SHY SMH

BleedNo-Bleed

VTE 3.0 DATA‘ALL’ BLEED PATIENT DISTRIBUTION BY LENGTH OF STAY - THA

31UPMC VTE 3.0

Aver

age

Leng

th o

f Sta

y (In

day

s)

0

2

4

6

8

10

12

HospitalBMC EAS HMC MCH MER MWH NWH PAS PUH SHY SMH

BleedNo-Bleed

VTE 3.0 DATA‘ALL’ BLEED PATIENT DISTRIBUTION BY LENGTH OF STAY - TKA

32UPMC VTE 3.0

UPMC VTE 3.0

VTE 3.0 DATA‘HAS-BLED’ DISTRIBUTION

H HYPERTENSION

33

A ABNORMAL RENAL/LIVER FUNCTION

S STROKE

B BLEEDING

L LABILE INRS

E ELDERLY (AGE >= 65)

D DRUGS OR ALCOHOL%

of P

atie

nts

0

10

20

30

40

HAS-BLED Scores

0 1 2 3 4 5 6

BleedNo -‐ Bleed

Bleed 31 88 161 180 111 40 5

No Bleed 1344 3461 5079 3928 1690 210 11

CLOT ANALYSISVTE 3.0

COMPARATIVE ANALYSIS CRITERIACLOT CRITERIA VTE 1.0


VTE treatment drugs Enoxaparin, Fondaparinux, Heparin in designated dosages Charges Definite Label

Clotting readmission ICD9 codes related to clot as readmission cause Diagnoses Definite Label

Thrombolytics drugs Alteplase Charges Potential label, corroborated with clotting keywords

IVC Filter Drop in hemoglobin >= 2 units in 48 hours after the surgery Labs Potential label, corroborated with

clotting keywords

Clotting Keywords EMR: Discharge Summary Potential Label, corroborated with manual examination of the EMR text

35UPMC VTE 3.0


CRITERIA DESCRIPTION SOURCE FILE

A VTE treatment drugs

Enoxaparin > 40mg or

Fondaparinux > 2.5mg or Heparin >= 25000 units

In one of the date after surgery

Charges

B Clotting Diagnosis Code ICD9 codes related to clot Diagnoses

C Doppler Positive The description of Doppler file specifically mentioned clot Doppler

Final Criteria

1. A patient satisfied Criteria A and B2. A patient satisfied either Criteria A or B, and also satisfied Criteria C at the same time

36UPMC VTE 3.0


37UPMC VTE 3.0

Charges CodesFilter

Diagnosis CodesFilter

Doppler Records

CT Records

MASTER FILE DECISION TREEBLACK BOX

Clotted Patients Non-Clotted Patients

VTE 3.0CLOT ANALYSIS FLOWCHART

LABELED DATA UNLABELED DATA

CLOT RESULT

TRAIN TEST

DEMOGRAPHICS

DIAGNOSES

CHARGES

PROCEDURES

DEMO_DIAG

DEMO_DIAG_CHARGES

ACCT_ID

MRN_ID

MRN_ID

MASTER

ALGORITHM

RAW DATA DATA CLEANING ANALYSIS

38UPMC VTE 3.0

COMPARATIVE ANALYSIS CLOT RESULTS

PROJECT ITERATION TOTAL PATIENTS CLOT CLOT % OVER IDENTIFICATION %

VTE 1.0 8173 187 2.29% 61%

VTE 2.0 8772 100 1.14% 22%

VTE 3.0 16343 136 0.83% 2.34%


39UPMC VTE 3.0

VTE 3.0 DATA

No - Clot 6344(99.64%)

Clot 23(0.63%)

THA No - Clot 9863(98.87%)

Clot 113(1.13%)

TKA

CLOT DISTRIBUTION

40UPMC VTE 3.0

VTE 3.0 DATA

CONFUSION PREDICTEDMATRIX No - Clot Clot

ACTUALNo - Clot 54 2

Clot 5 4

THA CLOT CONFUSION MATRIX

41UPMC VTE 3.0

CONFUSION PREDICTEDMATRIX No - Clot Clot

ACTUALNo - Clot 81 3

Clot 16 48

TKA CLOT CONFUSION MATRIX


Num

ber o

f Clo

t Pat

ient

s

0

3

5

8

10

% o

f Pat

ient

s w

ho C

lotte

d

0.00%

0.25%

0.50%

0.75%

1.00%

HospitalsBMC CHP EAS HMC MCH MER MWH NWH PAS PUH SHY SMH

VTE 3.0 DATATHA CLOT DISTRIBUTION BY HOSPITAL

42UPMC VTE 3.0

Clot 0 0 1 2 0 3 6 1 2 0 6 10

No Clot 19 1 301 443 65 338 1346 178 741 38 2524 1008

Clot% 0% 0% 0.33% 0.45% 0% 0.88% 0.44% 0.56% 0.27% 0% 0.24% 0.98%

Num

ber o

f Clo

t Pat

ient

s

0

13

25

38

50

% o

f Pat

ient

s w

ho C

lotte

d

0.00%

0.75%

1.50%

2.25%

3.00%

HospitalsBMC EAS HMC MCH MER MWH NWH PAS PUH SHY SMH

VTE 3.0 DATATKA CLOT DISTRIBUTION BY HOSPITAL

43UPMC VTE 3.0

Clot 0 5 5 3 15 36 2 21 0 24 46

No Clot 37 614 810 207 650 1899 206 1509 17 2565 2054

Clot% 0% 0.81% 0.61% 1.43% 2.26% 1.86% 0.96% 1.37% 0% 0.93% 2.19%

VTE 3.0 DATA%

of C

lot

0

18

35

53

70

Combination of Medications

1 2 3 4 5 6 7 8 9

THATKA

MEDICATIONS PRIOR TO SURGERY (FROM H&P FILE) - CLOT

1 ASPIRIN, APIXABAN 6 ASPIRIN, HEPARIN, ENOXAPARIN, WARFARIN, RIVAROXABAN2 HEPARIN, ENOXAPARIN, WARFARIN, RIVAROXABAN 7 HEPARIN, WARFARIN3 HEPARIN, ENOXAPARIN, WARFARIN 8 HEPARIN, WARFARIN, RIVAROXABAN4 ASPIRIN, HEPARIN, ENOXAPARIN, WARFARIN 9 ENOXAPARIN, WARFARIN, RIVAROXABAN5 ASPIRIN, HEPARIN, WARFARIN

44UPMC VTE 3.0

UPMC VTE 3.0

VTE 3.0 DATA

Num

ber o

f Clo

tted

Patie

nts

0

10

20

30

40

% o

f Pat

ient

s w

ho C

lotte

d

0.00%

0.45%

0.90%

1.35%

1.80%

A B C D E F G H

POST-OPERATIVE MEDICATIONS vs CLOT RATIO - THA

A WARFARIN

45

Clot 34 22 1 11 2 1 2 0

No_Clot 1853 1423 86 2276 680 443 1187 2

Clot% 1.8 1.52 1.15 0.48 0.29 0.23 0.17 0


B RIVAROXABAN 10MG TAB

C HEPARIN 5000 UNITS/ML

D ENOXAPARIN

E FONDAPARINUX 2.5MG INJ

F ASPIRIN 81MG TAB

G ASPIRIN 325 MG TAB


UPMC VTE 3.0

VTE 3.0 DATA

Num

ber o

f Clo

tted

Patie

nts

0

50

100

150

200

% o

f Pat

ient

s w

ho C

lotte

d0.00%

3.50%

7.00%

10.50%

14.00%

A B C D E F G H

POST-OPERATIVE MEDICATIONS vs CLOT RATIO - TKA

A HEPARIN 5000 UNITS/ML

46

Clot 9 195 16 24 50 22 6 0

No_Clot 64 3738 715 1213 3902 2577 1075 3

Clot% 12.33 4.96 2.19 1.94 1.27 0.85 0.56 0


B WARFARIN

C ASPIRIN 81MG TAB

D FONDAPARINUX 2.5MG INJ

E ENOXAPARIN

F RIVAROXABAN 10MG TAB

G ASPIRIN 325 MG TAB


VTE 3.0 DATADISTRIBUTION OF POST-OPERATIVE MEDICATIONS BY HOSPITAL - CLOT THA

47UPMC VTE 3.0

VTE 3.0 DATADISTRIBUTION OF POST-OPERATIVE MEDICATIONS BY HOSPITAL - CLOT TKA

48UPMC VTE 3.0

Aver

age

Leng

th o

f Sta

y (In

day

s)

0

2

4

6

8

10

12

HospitalBMC CHP EAS HMC MCH MER MWH NWH PAS PUH SHY SMH

ClotNo-Clot

VTE 3.0 DATACLOT PATIENT DISTRIBUTION BY LENGTH OF STAY - THA

49UPMC VTE 3.0

Aver

age

Leng

th o

f Sta

y (In

day

s)

0

1

2

3

4

5

6

7

HospitalBMC EAS HMC MCH MER MWH NWH PAS PUH SHY SMH

ClotNo-Clot

VTE 3.0 DATACLOT PATIENT DISTRIBUTION BY LENGTH OF STAY - TKA

50UPMC VTE 3.0

IMPACT OF PHYSICAL THERAPY%

of P

atie

nts

Get

ting

Clo

tted

0

2

5

7

9

Days to Physical Therapy After Surgery1 2 3 4 5 6 7

51UPMC VTE 3.0

Avg.

Num

ber o

f Day

s of

PT

0

1

2

3

4

5

6

HospitalEAS HMC MER MWH NWH PAS SHY SMH

ClotNo-Clot

VTE 3.0 DATAAVERAGE DAYS OF PHYSICAL THERAPY (PT) BY HOSPITAL - THA

52UPMC VTE 3.0

Avg.

Num

ber o

f Day

s of

PT

0

1

2

3

4

5

HospitalEAS HMC MCH MER MWH NWH PAS SHY SMH

ClotNo-Clot

VTE 3.0 DATAAVERAGE DAYS OF PHYSICAL THERAPY (PT) BY HOSPITAL - TKA

53UPMC VTE 3.0

UPMC VTE 3.0

VTE 3.0 DATACHADS2 DISTRIBUTION

C CONGESTIVE HEART FAILURE

54

H HYPERTENSION

A AGE >= 75

D DIABETES MELITUS

S2 STROKE/TIA/TE % o

f Pat

ient

s

0

13

25

38

50

CHADS2 Scores

0 1 2 3 4 5

ClotNo -‐ Clot

TAKE-AWAY

VTE 3.0

CLINICAL FINDINGS

56UPMC VTE 3.0

‘ALL’ BLEED TKA THA

MOST INEFFECTIVE MEDICATIONS PRIOR TO SURGERY

ASPIRIN + ENOXAPARIN + WARFARIN + DABIGATRAN HEPARIN + WARFARIN

MOST INEFFECTIVE POST-OPERATIVE MEDICATIONS

HEPARIN 5000 UNITS/ML(19.18% BLEED RATE)

ASPIRIN 81 MG TAB(7.66% BLEED RATE)

MOST EFFECTIVE POST-OPERATIVE MEDICATIONS

FONDAPARINUX 2.5 MG INJ(3.96% BLEED RATE)

ANDRIVAROXABAN 10 MG TAB

(2.31% BLEED RATE)

RIVAROXABAN 10 MG TAB (1.19% BLEED RATE)

AND HEPARIN 5000 UNITS/ML

(0.6% BLEED RATE)

AVERAGE LENGTH OF STAY(IN DAYS)(4 Days Across Hospitals)

PUH : 12 - BLEED, 5 - NO BLEEDSHY : 7 - BLEED, 3 - NO BLEED

MER : 7 - BLEED, 4 - NO BLEEDPUH : 6 - BLEED, 6 - NO BLEED

CLINICAL FINDINGS

57UPMC VTE 3.0

CLOT TKA THA

MOST INEFFECTIVE MEDICATIONS PRIOR TO SURGERY ASPIRIN + APIXABAN HEPARIN + WARFARIN + ENOXAPARIN +

RIVAROXABAN

MOST INEFFECTIVE POST-OPERATIVE MEDICATIONS

HEPARIN 5000 UNITS/ML(12.33% CLOT RATE)

AND WARFARIN

(4.96% CLOT RATE)

WARFARIN(1.8% CLOT RATE)

MOST EFFECTIVE POST-OPERATIVE MEDICATIONS

RIVAROXABAN 10 MG TAB(0.85% CLOT RATE)

ANDASPIRIN 325 MG TAB(0.56% CLOT RATE)

ASPIRIN 81 MG TAB(0.23% CLOT RATE)

ANDASPIRIN 325 MG TAB(0.17% CLOT RATE)

AVERAGE LENGTH OF STAY(IN DAYS)(4 Days Across Hospitals)

MCH : 7 - CLOT, 2 - NO CLOTMER : 7 - CLOT, 3 - NO CLOT

MER : 7 - CLOT, 4 - NO CLOTPAS : 12 - CLOT, 4 - NO CLOT

DATA INCONSISTENCY

58UPMC VTE 3.0

H&P Fileo Search for the ‘medications prior to surgery’ for every patient in data set

o Difficult to extract medications just on the basis of keywords

Unstructured EMR Fileo Search for the keywords ‘Doppler’ and ‘CT’ under the tab named ‘RAD’ (for radiology files)

o Manually search for the positive or negative keywords for ‘Thromboembolism’

DATA INCONSISTENCY

59UPMC VTE 3.0

H&P Fileo Search for the ‘medications prior to surgery’ for every patient in data set

o Difficult to extract medications just on the basis of keywords

Unstructured EMR Fileo Search for the keywords ‘Doppler’ and ‘CT’ under the tab named ‘RAD’ (for radiology files)

o Manually search for the positive or negative keywords for ‘Thromboembolism’

SCOPE OF IMPROVEMENT

60UPMC VTE 3.0

Analyzing the Interaction of Post-operative Medicationso Extracted individual medications and the patients on the regimen

o Further analyze the interaction of medications leading to bleed or clot condition

HAS-BLED and CHADS2 Criteriao Multiple patients with low scores getting bled or clotted and multiple patients with high scores NOT getting bled or

clotted

o Criteria like ‘hypertension history’ and ‘stroke history’ is difficult to identify

o Explore alternate scoring systems for identifying the risk of both ‘bleed’ and ‘clot’

WHAT WE DID BETTER

61

VTE 1.0

VTE 2.0

VTE 3.0

61%22%

2.34%

VTE 1.0

VTE 2.0

VTE 3.0

780%

83.7% 28.69%

CLOT OVER-IDENTIFICATION

BLEED OVER-IDENTIFICATION

UPMC VTE 3.0

AUTOMATED SYSTEM FOR

DATA PROCESSING

FLEXIBILE WINDOWING

BLEED CRITERIA

STRUCTURED LEARNING

CLOT CRITERIA

THANK YOU FORYOUR TIME

VTE 3.0

vte 3.0 final presentation

Documents