Project Summary / Abstract Dr. Yang is an Assistant Professor in the Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), and the Center for HealthCare Studies (CHS) – Institute for Public Health and Medicine at the Feinberg School of Medicine. CHS and SOQIC conduct cutting-edge research about the safety and quality of healthcare through interdisciplinary collaborations of health services and outcomes researchers in order to inform and shape healthcare policy and to improve healthcare practices and the health of the nation. Dr. Yang's career goal is to become an independently funded investigator combining advanced quantitative and qualitative analytics with expertise in implementation and dissemination science to facilitate effective healthcare quality improvement locally, regionally, and nationally. To fulfill this goal, he will augment his Master's Degree in Healthcare Quality and Patient Safety by gaining expertise in three areas during this award period: (1) implementation and dissemination science, (2) qualitative and mixed methods research, and (3) quantitative evaluation methods. He will apply the new knowledge and skills experientially to the proposed project. Venous thromboembolism (VTE), defined as either a deep venous thrombosis or pulmonary embolism (PE), is a common, preventable cause of postoperative morbidity and mortality. PE is the leading cause of in-hospital preventable death in the United States. The currently quality measures for VTE have important flaws that limit the ability of hospitals to identify actionable targets for quality improvement (QI). Therefore, at the request of the Centers for Medicare and Medicaid Services, our group created and validated a new VTE Prophylaxis Composite Measure that includes the three best practice elements of postoperative VTE prophylaxis: (1) chemoprophylaxis, (2) sequential compression devices, and (3) early ambulation. The measure helps hospitals easily identify actionable QI targets for VTE prophylaxis. This application proposes to use an intensive, mixed methods evaluation in twelve hospitals of four key types (large academic; large community; small/medium community with QI experience; small/medium community with little/no QI experience) to examine how hospitals differentially adapt and utilize the resource, ““Preventing Hospital-Associated Venous Thromboembolism: A Guide for Effective Quality Improvement” (VTE QI Guide) to address QI targets identified by the VTE Prophylaxis Composite Measure, while taking into account their hospital-specific contexts. The lessons learned will culminate in the development of “Tailored Adaptations of the AHRQ VTE QI Guide,” a companion to the VTE QI Guide, which will equip hospitals with practical strategies to adapt and implement the VTE QI Guide within their hospital type and local context. Finally, the value of tailored use of the VTE QI Guide will be assessed by comparing pre- and post-implementation adherence to the VTE Prophylaxis Composite Measure in the twelve hospitals.

Project Narrative Venous thromboembolism (VTE), which comprises both deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important clinical problem, particularly in surgical patients; PE is the most common preventable cause of hospital death. This goal of the proposed research is to: (1) identify how hospitals can use a novel, VTE prophylaxis process-of-care quality measure to identify actionable targets for improvement; and (2) evaluate how hospitals adapt the quality improvement resource, “Preventing Hospital-Associated Venous Thromboembolism: A Guide for Effective Quality Improvement” (VTE QI Guide) to their specific local environment to improve quality improvement targets for VTE prophylaxis. Lessons learned from evaluation of how diverse hospitals differentially adapt and use the VTE QI Guide will culminate in the creation of “Tailored Adaptations of the AHRQ VTE QI Guide,” a companion to the VTE QI Guide which will help diverse types of hospitals prospectively make adaptations to the VTE QI Guide to address their failures of VTE prophylaxis and reduce the number of patients who suffer as a result of this complication.