By: Emma Yasinski Oct. 27, 2017
Nearly a decade ago, the surgeon general published a call to action to improve prevention and treatment of deep vein thrombosis (DVT) a condition in which a blood clot forms in a patient’s legs and has the potential to break loose, travel toward the lungs, and lead to a life-threatening pulmonary embolism (PE.) “Why do DVT and PE remain such serious problems, particularly given the availability of effective strategies for preventing and minimizing them? The answer lies primarily in the failure to consistently use evidence-based interventions in those high-risk individuals who need them.” The summary stated.
In 2017, DVT remains a massive problem in healthcare – one that, by some estimates costs the country tens of billions of dollars and more importantly, tens of thousands of lives. The majority of patients who experience DVT suffer from it after a surgery. Two of the major risk factors for DVT are undergoing surgery and having previously experienced DVT. A recent analysis from Dexur showed that throughout the nation, a patient who suffers from DVT spends two and a half more days in the hospital than one who didn’t, and is readmitted to the hospital 2.18 percent more often. The data however, varied widely from hospital to hospital, potentially reflecting varied approaches to balancing effective prevention and treatment while minimizing cost.
One strategy to decrease the toll of excess hospitalization for those hospitals that can adopt it, is treating DVT patients in an outpatient setting. Alex Spyropoulos, MD, Professor at Hofstra Northwell School of Medicine, helped set up one of the first outpatient clinics for treating these patients in the 1990s. Dr. Spyropoulos explained to Dexur that “We were doing stuff that’s still not being done now, 20 years later. But, to set up an anticoagulation clinic takes a lot of money, and you don't get that much in terms of revenues. Hospitals have to buy in that this is a huge quality issue.” He has worked on several studies estimating the costs of DVT, one of which included developing a model of the overall economic burden including treatment and loss of work for patients, which predicted DVT costs the United States tens of billions of dollars.
The trend of outpatient anticoagulation treatment is catching on in some hospitals. “It became apparent that we were keeping patients in the hospital for the sole purpose of waiting for their blood thinner therapy to become therapeutic.” Said Adam Porath, PharmD, BCACP, BCPS-AQ Cardiology Ambulatory Pharmacy Manager at Renown Health. Six years ago, he developed the outpatient service to manage DVT patients. Last month, at the American society of Health System Pharmacist meeting, the group presented a study that showed they were able to decrease both length of stay and the overall cost of care for their DVT patients using the outpatient protocol.
But financial investment isn’t the only roadblock to setting up an effective anticoagulation clinic. “It’s got to be a local solution” said Spyropoulos. Much of the feedback Porath received after presenting Renown’s results was that some hospitals aren’t designed to provide this type of integrated care. The most important part is ensuring that patients get the treatment that they need for the appropriate length of time – whether it’s in the hospital or not. The cost of treatment along with the cost to stay in the hospital to receive that treatment is overwhelming, so the patient’s hospital stays are getting shorter. But that’s where the breakdown can happen. The patients aren’t transferred home or to long term care with prophylaxis, and end up sicker. “All of sudden, patients are not getting the appropriate duration of thromboprophylaxis.” he explained, “Unfortunately, we're actually going backwards.”