Abstract

BACKGROUND: Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at-risk patients. The process of providing VTE prophylaxis begins with assessing each patient's VTE risk. Using an individualized, point-based protocol in the assessment process is a complex task, and might contribute to variability in VTE prescribing behavior. There are no published data on how reliably residents can perform risk assessment and prophylaxis using a point-based VTE risk assessment tool. OBJECTIVE:: Our aim was to determine inter-rater reliability of a point-based risk assessment tool by residents early in the academic year. DESIGN:: The design was a cross-sectional-cohort observational study. SETTING:: The site was an academic medical center. PATIENTS:: Case-based clinical vignettes were used. INTERVENTIONS:: Verbal instructions were given to medical residents about how to apply our hospital's point-based VTE risk assessment tool. MEASUREMENTS:: Interobserver agreement was measured of: 1) risk score, 2) risk-stratification, 3) identification of contraindications, 4) VTE prophylaxis plan, and 5) resident adherence to the protocol. RESULTS:: The intra-class correlation (ICC) for the total risk score was 0.66 and the kappa coefficient for risk stratification was 0.51. The kappa scores for absolute and relative contraindications were 0.29 and 0.23, respectively. The kappa score for the VTE plan was 0.28. CONCLUSIONS:: We determined that, following brief instructions early in the academic year, a point-based VTE risk assessment tool has only fair to moderate inter-rater reliability, with suboptimal adherence to the protocol. Both might lead to underutilization of VTE prevention strategies.

Original languageEnglish (US)
Pages (from-to)127-133
Number of pages7
JournalJournal of Hospital Medicine
Volume6
Issue number4
DOIs
StatePublished - Apr 1 2011

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Process Assessment (Health Care)
Observational Studies
Cohort Studies
Guidelines
Mortality

All Science Journal Classification (ASJC) codes

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

@article{23054d90613840ae8fed291ccc78807f,
title = "Reliability of a point-based VTE risk assessment tool in the hands of medical residents",
abstract = "BACKGROUND: Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at-risk patients. The process of providing VTE prophylaxis begins with assessing each patient's VTE risk. Using an individualized, point-based protocol in the assessment process is a complex task, and might contribute to variability in VTE prescribing behavior. There are no published data on how reliably residents can perform risk assessment and prophylaxis using a point-based VTE risk assessment tool. OBJECTIVE:: Our aim was to determine inter-rater reliability of a point-based risk assessment tool by residents early in the academic year. DESIGN:: The design was a cross-sectional-cohort observational study. SETTING:: The site was an academic medical center. PATIENTS:: Case-based clinical vignettes were used. INTERVENTIONS:: Verbal instructions were given to medical residents about how to apply our hospital's point-based VTE risk assessment tool. MEASUREMENTS:: Interobserver agreement was measured of: 1) risk score, 2) risk-stratification, 3) identification of contraindications, 4) VTE prophylaxis plan, and 5) resident adherence to the protocol. RESULTS:: The intra-class correlation (ICC) for the total risk score was 0.66 and the kappa coefficient for risk stratification was 0.51. The kappa scores for absolute and relative contraindications were 0.29 and 0.23, respectively. The kappa score for the VTE plan was 0.28. CONCLUSIONS:: We determined that, following brief instructions early in the academic year, a point-based VTE risk assessment tool has only fair to moderate inter-rater reliability, with suboptimal adherence to the protocol. Both might lead to underutilization of VTE prevention strategies.",
author = "Beck, {Michael J.} and Paul Haidet and Krista Todoric and Erik Lehman and Chris Sciamanna",
year = "2011",
month = "4",
day = "1",
doi = "10.1002/jhm.860",
language = "English (US)",
volume = "6",
pages = "127--133",
journal = "Journal of Hospital Medicine",
issn = "1553-5606",
publisher = "Society of Hospital Medicine",
number = "4",

}

TY - JOUR

T1 - Reliability of a point-based VTE risk assessment tool in the hands of medical residents

AU - Beck, Michael J.

AU - Haidet, Paul

AU - Todoric, Krista

AU - Lehman, Erik

AU - Sciamanna, Chris

PY - 2011/4/1

Y1 - 2011/4/1

N2 - BACKGROUND: Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at-risk patients. The process of providing VTE prophylaxis begins with assessing each patient's VTE risk. Using an individualized, point-based protocol in the assessment process is a complex task, and might contribute to variability in VTE prescribing behavior. There are no published data on how reliably residents can perform risk assessment and prophylaxis using a point-based VTE risk assessment tool. OBJECTIVE:: Our aim was to determine inter-rater reliability of a point-based risk assessment tool by residents early in the academic year. DESIGN:: The design was a cross-sectional-cohort observational study. SETTING:: The site was an academic medical center. PATIENTS:: Case-based clinical vignettes were used. INTERVENTIONS:: Verbal instructions were given to medical residents about how to apply our hospital's point-based VTE risk assessment tool. MEASUREMENTS:: Interobserver agreement was measured of: 1) risk score, 2) risk-stratification, 3) identification of contraindications, 4) VTE prophylaxis plan, and 5) resident adherence to the protocol. RESULTS:: The intra-class correlation (ICC) for the total risk score was 0.66 and the kappa coefficient for risk stratification was 0.51. The kappa scores for absolute and relative contraindications were 0.29 and 0.23, respectively. The kappa score for the VTE plan was 0.28. CONCLUSIONS:: We determined that, following brief instructions early in the academic year, a point-based VTE risk assessment tool has only fair to moderate inter-rater reliability, with suboptimal adherence to the protocol. Both might lead to underutilization of VTE prevention strategies.

AB - BACKGROUND: Venous thromboembolic events (VTE) are a significant cause of mortality in hospitalized medical and surgical patients. Despite recommendations and guidelines, current evidence demonstrates that VTE prophylaxis remains underutilized in at-risk patients. The process of providing VTE prophylaxis begins with assessing each patient's VTE risk. Using an individualized, point-based protocol in the assessment process is a complex task, and might contribute to variability in VTE prescribing behavior. There are no published data on how reliably residents can perform risk assessment and prophylaxis using a point-based VTE risk assessment tool. OBJECTIVE:: Our aim was to determine inter-rater reliability of a point-based risk assessment tool by residents early in the academic year. DESIGN:: The design was a cross-sectional-cohort observational study. SETTING:: The site was an academic medical center. PATIENTS:: Case-based clinical vignettes were used. INTERVENTIONS:: Verbal instructions were given to medical residents about how to apply our hospital's point-based VTE risk assessment tool. MEASUREMENTS:: Interobserver agreement was measured of: 1) risk score, 2) risk-stratification, 3) identification of contraindications, 4) VTE prophylaxis plan, and 5) resident adherence to the protocol. RESULTS:: The intra-class correlation (ICC) for the total risk score was 0.66 and the kappa coefficient for risk stratification was 0.51. The kappa scores for absolute and relative contraindications were 0.29 and 0.23, respectively. The kappa score for the VTE plan was 0.28. CONCLUSIONS:: We determined that, following brief instructions early in the academic year, a point-based VTE risk assessment tool has only fair to moderate inter-rater reliability, with suboptimal adherence to the protocol. Both might lead to underutilization of VTE prevention strategies.

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U2 - 10.1002/jhm.860

DO - 10.1002/jhm.860

M3 - Article

C2 - 21480490

AN - SCOPUS:79953750109

VL - 6

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EP - 133

JO - Journal of Hospital Medicine

JF - Journal of Hospital Medicine

SN - 1553-5606

IS - 4

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