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INTRODUCTION: Acute lower extremity deep vein thrombosis (LE-DVT) is associated with significant morbidity, mortality, and resource utilization. We implemented a structured program for management of outpatients diagnosed with acute LE-DVT in a vascular laboratory and explored its impact on clinical management and resource utilization.
METHODS: Outpatients with unilateral duplex ultrasounds positive for acute LE-DVT over a 2 year period (pre- and post-implementation of a structured management program) were identified from a vascular laboratory. DVT pharmacotherapy and rates of both inpatient hospitalization and emergency department (ED) utilization were compared between years using Chi-Square and Fisher’s exact tests.
RESULTS: 95 acute unilateral LE-DVTs were identified in outpatients over the study period. Post-implementation of a structured management program, ED utilization for anticoagulation initiation decreased from 32% to 3% (P<0.001). This decrease was not accompanied by a significant change in rates of inpatient hospitalization (21% vs. 18%; P=0.761), suggesting that the reduction in ED utilization reflected a change in the location of outpatient pharmacotherapy initiation rather than a difference in admission criteria or DVT severity. A decrease in use of enoxaparin was observed between years (47% vs. 26%; P=0.040) and accompanied by a non-significant increase in use of oral Xa inhibitors (12% vs. 21%; P=0.245) as DVT pharmacotherapy.
CONCLUSIONS: A structured acute DVT management program can positively impact resource utilization through treatment in lower cost outpatient environments. This strategy has potential to improve value by delivering more efficient care at lower cost. Further research will explore impacts on cost, long-term outcomes, and satisfaction.