By Paul Govern

With the aid of a five-year, $3.8 million grant from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), Vanderbilt University Medical Center biostatistician Benjamin French, PhD, hospitalist Amanda Mixon, MD, MS, MSPH, and their multidisciplinary team will develop and test new clinical decision support (CDS) tools to facilitate timely prevention of potentially lethal hospital-acquired blood clots, also known as venous thromboembolism (VTE).

“Current tools for predicting and preventing VTE in the hospital setting are inadequate, which contributes to preventable deaths,” said French, professor of Biostatistics and principal investigator of the grant. “This funding enables us to refine and rigorously evaluate a prognostic model and clinical decision support system with the potential to significantly improve clinical practice and patient outcomes related to clot prevention.”

 Amanda Mixon, MD, MS

 VTE involves development of blood clots in the veins, often in the arms and legs, which can break loose and travel to the lungs, blocking blood flow. This injury, termed pulmonary embolism, is the most common cause of preventable hospital deaths, yet rates have not improved in 30 years. According to French, existing VTE risk assessment tools are burdensome for busy clinicians and their use has not been shown to reduce VTE rates.

                                                                    Benjamin French, PhD

French, Mixon and colleagues have already developed a highly accurate prognostic model that calculates a patient’s probability of developing VTE while hospitalized. The new project will further improve this model and create user-friendly CDS tools that seamlessly integrate it into clinicians’ workflow. The tools will pull data from electronic health records in real-time to calculate VTE risk, while also weighing bleeding risks from anticoagulation medications.

The team will conduct an 18-month randomized trial at VUMC comparing the prognostic model CDS system against usual care for VTE prevention. The pragmatic trial’s adaptive design will evaluate effectiveness in reducing VTE rates overall and in key subgroups. A complementary evaluation will identify best implementation strategies to maximize clinician adoption.

“Clinicians urgently need understandable, shareable tools that change VTE prevention behaviors and save lives,” said Mixon, associate professor of Medicine. “This research will yield the knowledge and CDS systems to achieve that goal, with potential for national impact.”

The researchers note their project aligns with the learning health system vision, where clinical care and research seamlessly integrate to improve outcomes.

A previous VUMC trial of pediatric hospital acquired-VTE prediction and prevention was recently reported in JAMA Network Open.

The study is supported by NIH grant R01-HL164482.