PB0940 - Guideline Implementation Successes and Barriers to Prevent Cancer Associated Thrombosis in Community and Rural Cancer Clinics

Background: The rates of venous thromboembolism (VTE) risk assessment and anticoagulation prophylaxis (AP) are low in oncology practices despite societal guidelines emphasizing their importance. Successful implementation models have been demonstrated in academic settings. No data is currently available on VTE prevention programs in rural and community-based clinics (CBCs).

Aims: To implement a multidisciplinary VTE prevention program in CBCs and rural cancer clinics located in the United States, assess the impact on rates of VTE education, risk assessment and AP, and to identify barriers to implementation.

Methods: The prospective implementation study included a rural cancer clinic (Central Vermont Medical Center, VT, USA) and a community-based multi-site practice (New England Cancer Specialists, Maine, USA). Implementation of the previously published Vermont model (JCOOP 2020) occurred over 6 months and rates of VTE education, risk assessment and AP were ascertained. Barriers were analyzed qualitatively using chart review and interview.

Results: Following implementation of a VTE prevention program, VTE education rates increased from < 5% to 100% (CBC) and 38% (rural cancer center), p< 0.001. VTE risk assessment rates increased from 2-5% to 95% in the CBC and 39% in the rural practice, p< 0.001. AP rates in high-risk patients were 27% in the CBC and 13% in the rural cancer center which was a significant increase as compared to < 2% prior to program implementation. Barriers to VTE risk stratification included accurate Khorana score utilization, electronic health record resources and provider knowledge and acceptance of program importance. Barriers to AP in high-risk patients included lack of familiarity with bleed risk assessments, concerns for bleeding, lack of guidance on duration of anticoagulation and patient financial concerns.

Conclusion(s): A multidisciplinary approach successfully increases VTE education, risk assessment and AP in CBC and rural cancer clinics. However, multiple systemic, provider and guideline related factors remain as barriers to implementation in these settings.