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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
COMPARATIVE ANALYSIS CRITERIABLEED CRITERIA VTE 2.0
CRITERIA DESCRIPTION SOURCE FILE LABEL STATUS
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
COMPARATIVE ANALYSIS CRITERIABLEED CRITERIA VTE 3.0
CRITERIA DESCRIPTION SOURCE FILE LABEL STATUS
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%
* 226 patients are common to both THA and TKA
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
* Patient data from 2012 - 2014* 226 patients are common to both THA and TKA
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
* Patient data from 2012 - 2014* 226 patients are common to both THA and TKA
* 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
Post-Operative Medications
B WARFARIN
C ENOXAPARIN
D APIXABAN 81MG TAB
E ASPIRIN 325 MG TAB
F FONDAPARINUX 2.5MG INJ
G RIVAROXABAN 10MG TAB
H APIXABAN 2.5MG 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
CRITERIA DESCRIPTION SOURCE FILE LABEL STATUS
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
COMPARATIVE ANALYSIS CRITERIACLOT CRITERIA VTE 2.0
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
COMPARATIVE ANALYSIS CRITERIACLOT CRITERIA 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%
* 226 patients are common to both THA and TKA
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
* Patient data from 2012 - 2014* 226 patients are common to both THA and TKA
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
Post-Operative Medications
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
H APIXABAN 2.5MG 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
Post-Operative Medications
B WARFARIN
C ASPIRIN 81MG TAB
D FONDAPARINUX 2.5MG INJ
E ENOXAPARIN
F RIVAROXABAN 10MG TAB
G ASPIRIN 325 MG TAB
H APIXABAN 2.5MG 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