Thrombophilia testing in the inpatient setting: impact of an educational intervention

Henry Kwang; Eric Mou; Ilana Richman; Andre Kumar; Caroline Berube; Rajani Kaimal; Neera Ahuja; Stephanie Harman; Tyler Johnson; Neil Shah; Ronald Witteles; Robert Harrington; Lisa Shieh; Jason Hom

doi:10.1186/s12911-019-0889-6

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Thrombophilia testing in the inpatient setting: impact of an educational intervention

Journal article

Open access

Peer reviewed

Thrombophilia testing in the inpatient setting: impact of an educational intervention

Henry Kwang, Eric Mou, Ilana Richman, Andre Kumar, Caroline Berube, Rajani Kaimal, Neera Ahuja, Stephanie Harman, Tyler Johnson, Neil Shah, …

BMC medical informatics and decision making, Vol.19(1), pp.167-167

08/20/2019

DOI: 10.1186/s12911-019-0889-6

PMCID: PMC6701078

PMID: 31429747

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Abstract

Background: Thrombophilia testing is frequently ordered in the inpatient setting despite its limited impact on clinical decision-making and unreliable results in the setting of acute thrombosis or ongoing anticoagulation. We sought to determine the effect of an educational intervention in reducing inappropriate thrombophilia testing for hospitalized patients. Methods: During the 2014 academic year, we implemented an educational intervention with a phase implementation design for Internal Medicine interns at Stanford University Hospital. The educational session covering epidemiology, appropriate thrombophilia evaluation and clinical rationale behind these recommendations. Their ordering behavior was compared with a contemporaneous control (non-medicine and private services) and a historical control (interns from prior academic year). From the analyzed data, we determined the proportion of inappropriate thrombophilia testing of each group. Logistic generalized estimating equations were used to estimate odds ratios for inappropriate thrombophilia testing associated with the intervention. Results: Of 2151 orders included, 934 were deemed inappropriate (43.4%). The two intervention groups placed 147 orders. A pooled analysis of ordering practices by intervention groups revealed a trend toward reduction of inappropriate ordering (p = 0.053). By the end of the study, the intervention groups had significantly lower rates of inappropriate testing compared to historical or contemporaneous controls. Conclusion: A brief educational intervention was associated with a trend toward reduction in inappropriate thrombophilia testing. These findings suggest that focused education on thrombophilia testing can positively impact inpatient ordering practices.

Education

High value care

Inpatient

Thrombophilia

Details

Title: Subtitle: Thrombophilia testing in the inpatient setting: impact of an educational intervention
Creators: Henry Kwang - Stanford University
Eric Mou - Stanford University
Ilana Richman - Yale University
Andre Kumar - Stanford Medicine
Caroline Berube - Stanford University
Rajani Kaimal - Stanford University
Neera Ahuja - Stanford Medicine
Stephanie Harman - Stanford University
Tyler Johnson - Stanford University
Neil Shah - Stanford University
Ronald Witteles - Stanford University
Robert Harrington - Stanford University
Lisa Shieh - Stanford Medicine
Jason Hom - Stanford Medicine
Resource Type: Journal article
Publication Details: BMC medical informatics and decision making, Vol.19(1), pp.167-167
DOI: 10.1186/s12911-019-0889-6
PMID: 31429747
PMCID: PMC6701078
NLM abbreviation: BMC Med Inform Decis Mak
ISSN: 1472-6947
eISSN: 1472-6947
Publisher: BioMed Central
Language: English
Date published: 08/20/2019
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
Record Identifier: 9984359773302771

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