Background
Methods
Developing and implementing the CDS
Study subjects
Data sources and measures
Data analysis
Results
Variable | Period 1 | Period 2 | Period 3 | P value | |
---|---|---|---|---|---|
Age (years) | Mean (SD) | 53.6 (19.1) | 53.6 (19.1) | 54.0 (18.9) | <0.01 |
Sex | Female | 40,333 (57.4%) | 58,506 (57.1%) | 28,799 (57.2%) | 0.56 |
Race | White | 38,317 (54.5%) | 56,095 (54.8%) | 27,039 (53.7%) | <0.01 |
Other | 31,547 (44.9%) | 45,984 (44.9%) | 23,109 (45.9%) | ||
Unknown | 419 (0.6%) | 329 (0.3%) | 223 (0.4%) | ||
Health Insurance | Self Pay | 841 (1.2%) | 1,258 (1.2%) | 501 (1.0%) | <0.01 |
Insured | 65,246 (92.8%) | 99,895 (97.5%) | 49,307 (97.9%) | ||
Unknown | 4,196 (6.0%) | 1,255 (1.2%) | 563 (1.1%) | ||
Weight (kg) | Mean (SD) | 82.3 (24.0) | 82.8 (24.1) | 82.8 (24.1) | <0.01 |
CrCl <30 | Yes | 5,159 (9.7%) | 7,547 (9.9%) | 3,828 (8.8%) | <0.01 |
No | 47,855 (90.3%) | 68,743 (90.1%) | 39,513 (91.2%) | ||
Length of Stay (days) | Mean (SD) | 5.2 (7.7) | 5.1 (7.6) | 5.2 (7.0) | <0.01 |
DRG Weight | Mean (SD) | 1.7 (1.9) | 1.7 (1.9) | 1.7 (2.0) | <0.01 |
Discharging Unit | Medicine | 2,488 (46.2%) | 47,973 (46.8%) | 24,373 (48.4%) | <0.01 |
Ortho/Trauma | 7,657 (10.9%) | 11,506 (11.2%) | 5,825 (11.6%) | ||
Other Surgery | 30,138 (42.9%) | 42,929 (41.9%) | 20,173 (40.0%) | ||
Top 5 Primary Discharge Diagnoses | First | Device complications 2,856 (4.4%) | Device complications 4,423 (4.5%) | Device complications 2,355 (4.8%) | NA |
Second | Osteoarthritis 2,327 (3.6%) | Osteoarthritis 3,505 (3.5%) | Osteoarthritis 1,805 (3.7%) | ||
Third | CAD 2,104 (3.3%) | CAD 3,342 (3.4%) | Dysrhythmia 1,676 (3.5%) | ||
Fourth | CHF 1,971 (3.0%) | Dysrhythmia 3,321 (3.4%) | CHF 1,460 (3.0%) | ||
Fifth | Dysrhythmia 1,940 (3.0%) | Birth complications 2,935 (3.0%) | CAD 1,419 (2.9%) |
Hospital | Discharge service | Period 1 | Period 2 | Period 3 | P-value |
---|---|---|---|---|---|
Hospital A | Medicine | 5,614 (36.7%) | 10,623 (46.2%) | 6,491 (54.6%) | <0.01 |
Ortho/Trauma | 659 (32.1%) | 1,215 (35.2%) | 746 (40.1%) | <0.01 | |
Other Surgery | 4,372 (25.1%) | 10,856 (42.9%) | 6,096 (52.5%) | <0.01 | |
All | 10,645 (30.6%) | 22,694 (43.9%) | 13,333 (52.5%) | <0.01 | |
Hospital B | Medicine | 3,460 (35.6%) | 6,648 (45.7%) | 3,661 (53.2%) | <0.01 |
Ortho/Trauma | 690 (34.5%) | 1,323 (42.9%) | 709 (44.1%) | <0.01 | |
Other Surgery | 584 (30.8%) | 1,393 (50.4%) | 771 (58.6%) | <0.01 | |
All | 4,734 (34.8%) | 9,364 (45.9%) | 5,141 (52.4%) | <0.01 | |
Hospital C | Medicine | 581 (7.8%) | 4,897 (47.0%) | 3,411 (61.0%) | <0.01 |
Ortho/Trauma | 2,052 (57.0%) | 2,797 (56.3%) | 1,390 (58.9%) | 0.10 | |
Other Surgery | 1,005 (9.3%) | 4,265 (28.7%) | 2,847 (39.3%) | <0.01 | |
All | 3,638 (16.6%) | 11,959 (39.5%) | 7,648 (50.3%) | <0.01 | |
Overall | Medicine | 9,655 (29.7%) | 22,168 (46.2%) | 13,563 (55.6%) | <0.01 |
Ortho/Trauma | 3,401 (44.4%) | 5,335 (46.4%) | 2,845 (48.8%) | <0.01 | |
Other Surgery | 5,961 (19.8%) | 16,514 (38.5%) | 9,714 (48.2%) | <0.01 | |
All | 19,017 (27.1%) | 44,017 (43.0%) | 26,122 (51.9%) | <0.01 |
Hospital | Discharge service | Period 1 | Period 2 | Period 3 | P-value |
---|---|---|---|---|---|
Hospital A | Medicine | 8,021 (52.4%) | 15,405 (67.0%) | 8,655 (72.8%) | <0.01 |
Ortho/Trauma | 1,275 (62.0%) | 3,035 (87.9%) | 1,808 (97.2%) | <0.01 | |
Other Surgery | 9,344 (53.7%) | 20,273 (80.2%) | 9,726 (83.7%) | <0.01 | |
All | 18,640 (53.6%) | 38,713 (74.8%) | 20,189 (79.6%) | <0.01 | |
Hospital B | Medicine | 4,937 (50.8%) | 9,306 (64.0%) | 4,510 (65.5%) | <0.01 |
Ortho/Trauma | 826 (41.3%) | 2,810 (91.0%) | 1,548 (96.4%) | <0.01 | |
Other Surgery | 981 (51.7%) | 1,989 (71.9%) | 1,088 (82.7%) | <0.01 | |
All | 6,744 (49.6%) | 14,105 (69.1%) | 7,146 (72.9%) | <0.01 | |
Hospital C | Medicine | 5,553 (74.3%) | 8,123 (77.9%) | 4,445 (79.4%) | <0.01 |
Ortho/Trauma | 2,947 (81.8%) | 4,682 (94.3%) | 2,294 (97.3%) | <0.01 | |
Other Surgery | 5,932 (54.8%) | 10,878 (73.1%) | 5,257 (72.7%) | <0.01 | |
All | 14,432 (65.9%) | 23,683 (78.3%) | 11,996 (79.0%) | <0.01 | |
Overall | Medicine | 18,511 (57.0%) | 32,834 (68.4%) | 17,610 (72.3%) | <0.01 |
Ortho/Trauma | 5,048 (65.9%) | 10,527 (91.5%) | 5,650 (97.0%) | <0.01 | |
Other Surgery | 16,257 (53.9%) | 33,140 (77.2%) | 16,071 (79.7%) | <0.01 | |
All | 39,816 (56.7%) | 76,501 (74.7%) | 39,331 (78.1%) | <0.01 |
Hospital | Discharge service | Period 1 | Period 2 | Period 3 | P-value |
---|---|---|---|---|---|
Hospital A | Medicine | 6,753 (44.1%) | 10,977 (47.7%) | 6,662 (56.0%) | <0.01 |
Ortho/Trauma | 1,121 (54.5%) | 2,207 (63.9%) | 1,301 (69.9%) | <0.01 | |
Other Surgery | 6,623 (38.0%) | 11,638 (46.0%) | 6,162 (53.0%) | <0.01 | |
All | 14,497 (41.7%) | 24,822 (48.0%) | 14,125 (55.7%) | <0.01 | |
Hospital B | Medicine | 4,455 (45.9%) | 7,136 (49.0%) | 3,792 (55.1%) | <0.01 |
Ortho/Trauma | 710 (35.5%) | 1,355 (43.9%) | 730 (45.5%) | <0.01 | |
Other Surgery | 911 (48.0%) | 1,563 (56.5%) | 800 (60.8%) | <0.01 | |
All | 6,076 (44.6%) | 10,054 (49.3%) | 5,322 (54.3%) | <0.01 | |
Hospital C | Medicine | 4,330 (57.9%) | 6,067 (58.2%) | 3,538 (63.2%) | <0.01 |
Ortho/Trauma | 2,103 (58.4%) | 2,902 (58.4%) | 1,463 (62.0%) | <0.01 | |
Other Surgery | 2,498 (23.1%) | 4,862 (32.7%) | 2,968 (41.0%) | <0.01 | |
All | 8,931 (40.8%) | 13,831 (45.7%) | 7,969 (52.5%) | <0.01 | |
Overall | Medicine | 15,538 (47.8%) | 24,180 (50.4%) | 13,992 (57.4%) | <0.01 |
Ortho/Trauma | 3,934 (51.4%) | 6,464 (56.2%) | 3,494 (60.0%) | <0.01 | |
Other Surgery | 10,032 (33.3%) | 18,063 (42.1%) | 9,930 (49.2%) | <0.01 | |
All | 29,504 (42.0%) | 48,707 (47.6%) | 27,416 (54.4%) | <0.01 |
A. From time period 1 to time period 2
| ||||||||
Hospital A | Hospital B | Hospital C | Overall | |||||
Baseline | Increase | Baseline | Increase | Baseline | Increase | Baseline | Increase | |
Recommended (%) | 31.5 | 3.2 (p=0.09) | 34.5 | 6.7 (p<.01) | 16.4 | 13.9 (p<.01) | 27.1 | 7.9 (p<.01) |
Any Prophylaxis (%) | 55.0 | 10.3 (p<.01) | 49.5 | 13.0 (p<.01) | 65.5 | 6.6 (p<.01) | 57.2 | 9.6 (p<.01) |
B. From time period 1 to time periods 2 and 3
| ||||||||
Hospital A | Hospital B | Hospital C | Overall | |||||
Baseline | Increase | Baseline | Increase | Baseline | Increase | Baseline | Increase | |
Recommended (%) | 30.9 | 3.7 (p=0.03) | 34.5 | 5.4 (p=0.01) | 16.4 | 13.6 (p<.01) | 27.2 | 6.6 (p<.01) |
Any Prophylaxis (%) | 55.3 | 10.4 (p<.01) | 49.5 | 14.6 (p<.01) | 65.5 | 7.2 (p<.01) | 57.5 | 9.6 (p<.01) |
Period 1
|
Period 2
|
Period 3
|
P Value
| |
---|---|---|---|---|
Hospital A
| ||||
DVT | 2.27 (%) | 2.27 (%) | 1.56 (%) | <0.01 |
PE | 0.68 (%) | 0.71 (%) | 0.80 (%) | 0.34 |
DVT/PE | 2.82 (%) | 2.80 (%) | 2.18 (%) | <0.01 |
Hospital B
| ||||
DVT | 1.05 (%) | 0.88 (%) | 0.44 (%) | <0.01 |
PE | 0.42 (%) | 0.41 (%) | 0.71 (%) | <0.01 |
DVT/PE | 1.42 (%) | 1.20 (%) | 1.09 (%) | 0.06 |
Hospital C
| ||||
DVT | 1.64 (%) | 1.67 (%) | 1.08 (%) | <0.01 |
PE | 0.29 (%) | 0.27 (%) | 0.62 (%) | <0.01 |
DVT/PE | 1.83 (%) | 1.86 (%) | 1.48 (%) | 0.10 |
Overall
| ||||
DVT | 1.77 (%) | 1.75 (%) | 1.15 (%) | <0.01 |
PE | 0.52 (%) | 0.53 (%) | 0.74 (%) | <0.01 |
DVT/PE | 2.18 (%) | 2.15 (%) | 1.73 (%) | <0.01 |