Program Description

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ACTIVITY PURPOSE:
More than 900,000 venous thromboembolism (VTE) events occur annually in the United States and the incidence of VTE has not changed significantly in the past 25 years, despite medical advances.[1,2] Moreover, an estimated 30% of patients who have a VTE event die within 30 days and the same percentage will experience a recurrent VTE within 10 years.[3] These data indicate a need to build appreciation of the clinical impact of VTE and the need for appropriate VTE management practices and led to a recent call to action by the US Surgeon General for a plan to reduce the US incidence of deep vein thrombosis (DVT) and pulmonary embolism.[4]
The Agency for Healthcare Research and Quality states that implementing an appropriate VTE risk stratification and prevention plan is the number one way for US hospitals to promote patient safety and reduce costs; however, despite recommendations, fewer than 50% of hospitalized patients diagnosed with DVT receive prophylaxis.[3-5] Evidence-based guidelines, including the recently updated 8th edition American College of Chest Physicians guidelines, also emphasize the importance of VTE risk stratification and appropriate methods of prophylaxis, yet data indicate an ongoing lack of adherence to evidence-based recommendations.[6-8] Not only can prophylaxis prevent costly and clinically significant VTE events, but data show VTE prophylaxis can be cost-saving with an average savings of $1000 per discharge.[9] Furthermore, research stresses the importance of healthcare education on VTE prevention, with hospital-targeted education directly linked to significant improvements in quantity and quality of VTE prophylaxis.[5,10,11] With the increased complexity of VTE patient care in special populations and the need for close monitoring, hospital-based clinicians can greatly benefit from education to ensure appropriate medication direction and selection, based on current guidelines and evidence.

REFERENCES
1. Heit J, Petterson T, Farmer S, Bailey K, Melton L. Trends in incidence of deep vein thrombosis and pulmonary embolism: a 35-year population-based study. Blood. 2006;108:430A.
2. Heit J, Cohen A, Anderson FJ. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood. 2005;106:267A.
3. Michota FA. Bridging the gap between evidence and practice in venous thromboembolism prophylaxis: the quality improvement process. J Gen Intern Med. 2007;22:1762-1770.
4. US Department of Health and Human Services. The surgeon general's call to action to prevent deep vein thrombosis and pulmonary embolism. http://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdf. Accessed August 24, 2009.
5. Diagnosis and Treatment of Deep Vein Thrombosis and Pulmonary Embolism. Agency for Healthcare Research and Quality Web site. http://www.ahrq.gov/downloads/pub/evidence/pdf/dvt/dvt.pdf. Accessed August 24, 2009.
6. Kearon C, Kahn SR, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 suppl):454S-545S.
7. Yu HT, Dylan ML, Lin J, Dubois RW. Hospitals' compliance with prophylaxis guidelines for venous thromboembolism. Am J Health Syst Pharm. 2007;64(1):69-76.
8. Nutescu EA. Assessing, preventing, and treating venous thromboembolism: evidence-based approaches. Am J Health Syst Pharm. 2007;64(11 Suppl 7):S5-S13.
9. Medical News: Venous Thrombosis. Medpage Today Website. http://www.medpagetoday.com/Cardiology/VenousThrombosis/15600. Accessed August 24, 2009.
10. Cohn SL, Adekile A, Mahabir V. Improved use of thromboprophylaxis for deep vein thrombosis following an educational intervention. J Hosp Med. 2006;1:331-338.
11. Dobesh PP, Stacy ZA. Effect of a clinical pharmacy education program on improvement in the quantity and quality of venous thromboembolism prophylaxis for medically ill patients. J Manag Care Pharm. 2005;11(9):755-762.

Learning Objectives

After completing this activity, participants should be able to:

• Apply evidence-based guidelines and quality measures for VTE risk stratification in the acute-care setting
• Implement guideline-based VTE prophylaxis in at-risk hospitalized patients
• Promote adherence to evidence-based VTE prophylaxis to ensure continuity of care post-discharge

Target Audience

This activity is designed for hospital-based and other physicians and allied healthcare professionals involved in the management of patients at-risk for VTE.

Faculty/Disclosures

Thomas DeLoughery, MD, FACP
Professor of Medicine, Pathology, and Pediatrics
Divisions of Hematolgy/Medical Oncology
and Laboratory Medicine
Oregon Health and Science University
Portland, Oregon

Moderator:
Matthew Sorrentino, MD, FACC
Professor of Medicine
University of Chicago Pritzker School of Medicine
Department of Medicine
Section of Cardiology
The University of Chicago
Chicago, Illinois

Independent Clinical Reviewer: Kenneth A. Bauer, MD, Professor of Medicine, Harvard Medical School, Director, Thrombosis Clinical Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Nurse Reviewer: Ruth Morrison, RN, BSN, CVN, Clinical Research Coordinator, VTE Research Group, Brigham and Women's Hospital, Boston, Massachusetts

Planning Committee
The planning committee comprises Kenneth A. Bauer, MD, Thomas DeLoughery, MD, FACP, Ruth Morrison, RN, BSN, CVN; Kristin Dickie, Mary Johnson, Randy Robbin, and John Savage, NACCME.

Financial Disclosure and Conflicts of Interest
According to the disclosure policy of NACCME, faculty, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant financial relationships with relevant commercial companies related to this activity. All relevant conflicts of interest that are identified are reviewed for potential conflicts of interest. If a conflict is identified, it is the responsibility of NACCME to initiate a mechanism to resolve the conflict(s). The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation.

All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

The faculty has reported the following:
Dr. Bauer: Consultant—Bayer Healthcare, Johnson and Johnson; Promotional speakers bureau—GlaxoSmithKline; Board member—GTC Biotherapeutics Corporation
Dr. DeLoughery: Consultant—Amgen; Promotional speakers bureau—Alexion, Amgen, GlaxoSmithKline, and sanofi-aventis U.S.
Ms. Morrison: Consultant—sanofi-aventis U.S.
Dr. Sorrentino: Promotional speakers bureau—Novartis, Merck and Co., Inc, Pfizer, Takeda

Ms. Dickie, Ms. Johnson, Mr. Robbin, and Mr. Savage have disclosed no relevant financial relationships with any commercial interests.

Accreditation

CME Accreditation
North American Center for Continuing Medical Education, LLC (NACCME) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

NACCME designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CPE Accreditation
North American Center for Continuing Medical Education, LLC (NACCME) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is approved for 0.5 contact hour (0.05 CEU) of continuing pharmacy education (UAN 276-000-09-035-H01-P).

Any participant wanting to file a grievance with respect to any aspect of a continuing pharmacy education activity accredited by NACCME may contact John Savage, Director, Medical Education, NACCME, in writing at 300 Rike Drive, Suite A, Millstone Township, NJ 08535, or by e-mail at jsavage@naccme.com. The Director of Medical Education will review the grievance and respond within 30 days of receiving the written statement. If the participant is unsatisfied with the response, an appeal to the Vice President, Medical Education, NACCME, may be made for a second level of review.

This educational activity is a knowledge-based activity.

CNE Accreditation
North American Center for Continuing Medical Education, LLC (NACCME) is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

This continuing nursing education activity was approved for 0.5 contact hour(s).

Provider approved by the California Board of Registered Nursing, Provider #13255 for 0.5 contact hour(s).

Provider

Sponsored by North American Center for Continuing Medical Education, LLC

Commercial Support

Supported by an educational grant from sanofi-aventis U.S.

Disclosure of Unlabeled Use

NACCME requires faculty to inform participants whenever off-label/unapproved uses of drugs and/or devices are discussed in their presentations.

The faculty has disclosed that no off-label/unapproved use(s) of drugs and/or devices will be discussed.

Instruction for Participation

Activity Overview
This audio activity is available via ReachMD Satellite Radio XM 160, www.reachmd.com, and the ReachMD MedicalRadio iPhone Application.

To be eligible for documentation of credit, participants must participate in the full activity, complete the 5-question online post-test with a score of 80% or better, and complete the evaluation form. After successful completion of the post-test and evaluation form online at www.reachmd.com, participants may immediately print their documentation of credit. 

There is no fee associated with this activity.

Participants who have successfully completed the live version of this activity are not eligible to receive credit for this activity.

Release Date: December 16, 2009
Expiration Date: December 16, 2010
Estimated time to complete: 0.5 hour

For questions regarding this educational activity, please contact info@reachmd.com, or call 847-205-9075.

Hardware/Software Requirements
All educational activities are accessible via a computer with 1.0 GHz PC, 1 GB RAM, Windows or MAC operating system, Internet Explorer (version 6.0 and above), Firefox (version 3.0 and above), or Safari (version 3.0 and above) browsers. Windows Media Player, sound card, and speakers are required for streamed audio. Flash Player, sound card, and speakers are required for video programs. A PDF reader is required for print publications. Please direct technical questions to info@reachmd.com

Legal Disclaimer

Privacy Policy
NACCME protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. NACCME and our joint sponsors will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

NACCME maintains physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Copyright © 2009 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from North American Center for Continuing Medical Education.