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Computer Assisted
Risk Assessment
for Deep Vein Thrombosis
Prophylaxis, CARAD,
is a computer program created by a physician. CARAD
provides a number of benefits to the healthcare professional
and hospitals, including accurate risk assessment of
deep venous thrombosis and generates complete prophylaxis
order sheet for faster treatment decisions. CARAD
can by used on the hospital main frame stand alone computers,
and is also compatible with handheld computer devices.
Correctly interpreting the risk for deep venous thrombosis
is the first step in preventing deep venous thrombosis
and pulmonary embolism. This software simplifies that
task, makes the process faster, and expedites the treatment
of the patient for more efficient care. This software
helps both physicians and hospitals to keep encounters
of risks of their population for deep venous thrombosis
and allows hospitals to meet the Joint Commission on
Accreditation of Healthcare Organizations accreditation
for deep venous thrombosis prophylaxis standards.
(Screen
Shots)
(Download CARAD Demo Video)
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Some
Causes of Death in the U.S
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Number
of Annual Deaths
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Pulmonary
Embolism 1,2
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up to
200,000
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AIDS 3
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14,499
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Breast Cancer 4
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40,200
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Highway Fatalities 5
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42,116
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An estimate of 200,000 to 600,000 Americans will suffer from
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), each
year. In the U.S. more people die each year from Pulmonary
Embolism than highway fatalities, breast cancer, and AIDS.
The American public is unaware of this preventable problem,
(pulmonary embolism).
Pulmonary
Embolism is a silent killer, often presenting itself with
no obvious signs or symptoms. In fact death may be the first
sign of a Pulmonary Embolism. Who is at Risk?
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Risk
Factors for Pulmonary Embolism
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| Increasing
Age |
Obesity |
| Prolonged
Mobility |
Varicose
Veins |
| Stroke |
Congestive
Heart Failure and Myocardial Infarction |
| Paralysis
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Indwelling
Central Venous Catheters |
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Previous
Venous Thromboembolism
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Inflammatory
Bowel Disease |
| Cancer
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Nephrotic
Syndrome |
Major
Surgery, operations involving the
Abdomen, Pelvis, and Lower Extremities |
Pregnancy,
Oral Contraceptives or
Post Menopausal Hormone Replacement |
| Respiratory
Failure, Pneumonia |
Inherited
Predisposition for Clotting |
Trauma,
especially fractures of Pelvis,
Hip or Lower Extremities |
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Barriers
for Deep Venous Thrombosis Prevention:
-
Lack of attention to accessing a patients Risk Factors.
- No
routine prophylaxis for patients at risks for Thrombosis
Occurs.
- Even
if acknowledging the Risks, there is a lack of prescribing
prophylaxis.
- Lack
of Awareness of Thrombosis Risk, due to perception by
Physicians of differences in risk for PE and perceived
risks of bleeding with prophylaxis.
- Hospital
Systems create failure modes.
- Protocols
and guidelines sit idle in drawers and never utilized.
- Lack
of utilization of evidence base medicine in routine daily
medical practice,
prevents optimum utilization of appropriate deep venous
thrombosis
prophylaxis.
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Unblocking
barriers for Deep Venous Thrombosis Prevention:
- Improving
standards of care and enhancing physician training.
- Certification
Program sponsored by the Joint Commission on Accreditation
of Healthcare Organizations, (JCAHO) to increase the
use of evidence base medicine as a focal point for
disease specific patient care services or programs.
- JCAHO
makes Deep Venous Thrombosis Prophylaxis a component
of a hospital approved accreditation process.
- American
Medical Association Physician Consortium for Performance
Measurement, to become a leader in evidence-based
performance measures and outcomes reporting tools
for physicians.
- Encourage
site medical licensing boards to include DVT and PE
prevention in their continuing medical education licensing
renewal requirements.
- Changing
the medical healthcare systems to address a system-wide
approach to
DVT Prevention, by use of Computer Assisted Programs.
- Encourage
policy makers to support reimbursement of DVT and
PE prevention
and treatment.
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"
Electronic Alerts to prevent venous thromboembolism among
hospitalized patients".
Kucher N, Koo S, Quiroz R, et al, N England Journal of Medicine,
2005, 352:969-977;
The results suggest that an electronic alert system can increase
the use of Venous Thromboembolism prophylaxis and lead to
a reduction in the rates of symptomatic
DVT and PE among "at risk" hospitalized patients.
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CARAD,
Computerized Assisted Risk Assessment of Deep Venous
Thrombosis, provides Evidence Based Medicine to guide
therapy and bases prophylaxis on the Risks Assessment
Score of each individual patient hospitalized, and when
utilizing system default therapy lowers the risks of
omission for DVT prevention. CARAD,
program will generate Risks Assessment Score and OrderSheets
for DVT Prophylaxis that are easy to read and implement.
CARAD, will generate
a global hospital database to encourage and use to defend
to JCAHO a hospital wide DVT/PE prevention therapy,
which will certify any hospital of JCAHO requirements.
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Contact
for more information
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Richard
Prager MD FCCP
Clinical Medical Director of Intensive Care
CEO/CARAD PA/Intensive Care Services PA
8950 SW 57 Avenue
Pinecrest, Florida 33156
Telephone: (305) 322-4116
Fax: (305) 666-2252
email: max4252@ bellsouth.net |
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References:
1. Anderson
FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based
perspective
of the hospital incidence and case-fatality rates of deep-vein
thrombosis and
pulmonary embolism: The Worcester DVT study. Arch Intern
Med. 1991;151:
933-938.
2. Silverstein
M, Heit J, Mohr D, et al. Trends in the incidence of Deep-Vein
Thrombosis
and Pulmonary Embolism: A 25 year Population-Based Study.
Arch Intern Med.
1998;158:585-593.
3. Centers
for Disease Control Report. HIV/AIDS Surveillance Report
2001. Vol. 13,
Number 2.
4. American
Cancer Society. Breast cancer facts and figures, 2001-2002.
Available at:
http://www.cancer.org/eprise/main/docroot/stt/content/STT
1x Breast Cancer Facts
and Figures 2001-2002. Accessed January 31, 2002.
5. National
Highway and Traffic Safety Association. Fatality Analysis
Reporting System
(FARS) Web-Based Encyclopedia. Available at: http://www-fars.nhtsa.dot.gov.
Accessed January 31, 2002.
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