An initiative to improve adherence to guidelines for thromboprophylaxis among high-risk gynecologic oncology patients receiving outpatient chemotherapy (293)

Abstract

Objectives: Pharmacologic thromboprophylaxis is recommended for high-risk gynecologic oncology patients with a Khorana score (KS) ≥ 2 receiving outpatient chemotherapy. Our objective was to evaluate the impact of a quality improvement (QI) project designed to increase KS calculation and documentation of thromboprophylaxis eligibility for patients initiating outpatient chemotherapy. Methods: In January 2021, the Society of Gynecologic Oncology endorsed guidelines recommending thromboprophylaxis for gynecologic oncology patients with a KS ≥ 2 receiving outpatient chemotherapy. The primary barriers to the implementation of these guidelines at the author’s institution included provider awareness, KS calculation, and documentation of eligibility. Starting June 2021, a KS calculator and associated thromboprophylaxis algorithm were incorporated into outpatient documentation templates. Eligible patients included those with gynecologic malignancies initiating a new chemotherapy regimen from January to September 2021. The percentages of patients for whom KS and thromboprophylaxis eligibility were documented at the start of the first cycle pre- and post-QI initiative were compared using the Chi-square test. The percentages of eligible patients who were offered and initiated thromboprophylaxis (apixaban 2.5 mg twice daily) in accordance with the algorithm were also assessed. Results: There were 119 total new chemotherapy cases identified in the study time frame: 61 pre-QI (51.3%) and 58 post-QI (48.7%). Of these, 34.4% (21/61) and 34.5% (20/58) were eligible for thromboprophylaxis pre- and post-QI, respectively. Table 1 demonstrates percentages of patients for whom KS calculation and thromboprophylaxis eligibility were documented prior to cycle 1 initiation. There was a statistically significant increase in documentation following QI initiation (pre-QI: 8/61 [13.1%], post-QI: 38/58 [65.5%]; p < 0.001). Of those who were eligible, 9.5% were offered thromboprophylaxis pre-QI (2/21) and 65% post-QI (13/20) (p < 0.001). Table 1 describes the percentages of eligible patients initiating thromboprophylaxis in accordance with the recommendations. There were no new venous thromboembolic events among eligible patients’ pre-QI and one post-QI. Conclusions: Over one-third of gynecologic cancer patients starting outpatient chemotherapy met eligibility criteria for pharmacologic thromboprophylaxis. Following the implementation of our QI initiative, there was an increase in KS calculation, documentation, and appropriate prescription of thromboprophylaxis among eligible patients. Studies are ongoing to measure patient adherence to pharmacologic thromboprophylaxis and to determine if adherence to thromboprophylaxis guidelines improves outcomes in this population. Objectives: Pharmacologic thromboprophylaxis is recommended for high-risk gynecologic oncology patients with a Khorana score (KS) ≥ 2 receiving outpatient chemotherapy. Our objective was to evaluate the impact of a quality improvement (QI) project designed to increase KS calculation and documentation of thromboprophylaxis eligibility for patients initiating outpatient chemotherapy. Methods: In January 2021, the Society of Gynecologic Oncology endorsed guidelines recommending thromboprophylaxis for gynecologic oncology patients with a KS ≥ 2 receiving outpatient chemotherapy. The primary barriers to the implementation of these guidelines at the author’s institution included provider awareness, KS calculation, and documentation of eligibility. Starting June 2021, a KS calculator and associated thromboprophylaxis algorithm were incorporated into outpatient documentation templates. Eligible patients included those with gynecologic malignancies initiating a new chemotherapy regimen from January to September 2021. The percentages of patients for whom KS and thromboprophylaxis eligibility were documented at the start of the first cycle pre- and post-QI initiative were compared using the Chi-square test. The percentages of eligible patients who were offered and initiated thromboprophylaxis (apixaban 2.5 mg twice daily) in accordance with the algorithm were also assessed. Results: There were 119 total new chemotherapy cases identified in the study time frame: 61 pre-QI (51.3%) and 58 post-QI (48.7%). Of these, 34.4% (21/61) and 34.5% (20/58) were eligible for thromboprophylaxis pre- and post-QI, respectively. Table 1 demonstrates percentages of patients for whom KS calculation and thromboprophylaxis eligibility were documented prior to cycle 1 initiation. There was a statistically significant increase in documentation following QI initiation (pre-QI: 8/61 [13.1%], post-QI: 38/58 [65.5%]; p < 0.001). Of those who were eligible, 9.5% were offered thromboprophylaxis pre-QI (2/21) and 65% post-QI (13/20) (p < 0.001). Table 1 describes the percentages of eligible patients initiating thromboprophylaxis in accordance with the recommendations. There were no new venous thromboembolic events among eligible patients’ pre-QI and one post-QI. Conclusions: Over one-third of gynecologic cancer patients starting outpatient chemotherapy met eligibility criteria for pharmacologic thromboprophylaxis. Following the implementation of our QI initiative, there was an increase in KS calculation, documentation, and appropriate prescription of thromboprophylaxis among eligible patients. Studies are ongoing to measure patient adherence to pharmacologic thromboprophylaxis and to determine if adherence to thromboprophylaxis guidelines improves outcomes in this population.