2025 Southeastern Residency Conference

Title: Evaluation of Thrombophilia Testing in a VHA Healthcare Facility Before and After Implementation of a New Thrombophilia Testing Protocol
Authors: Katherine Medley, Jill Radford, Rebecca Worsham, Shouji Nagata
Background/Purpose: The James H Quillen VA Medical Center (JHQVAMC) does not currently have a standardized process for thrombophilia testing.  Testing for thrombophilia should be used to identify the cause of severe or fatal venous thromboembolism (VTE), aid in decision making on future VTE prevention, and direct family member testing.  Most risk classification guidelines for VTE recurrence do not consider thrombophilia test results.  There is a lack of evidence supporting the clinical benefit of routine testing among patients with VTE.  The accuracy and reliability of thrombophilia testing is dependent on the timing of the tests in association with the initial VTE presentation or the presence of an anticoagulant. Inaccurate testing can lead to false positive or false negative results.  These false results may contribute to patient harm through unnecessary prolonged duration of anticoagulation,  inaccurate diagnosis of thrombophilia, or providing false assurance related to the risk of recurrent VTE.  Studies have shown that thrombophilia testing increases the cost of VTE management without adding meaningful clinical value.  The purpose of this quality improvement project is to develop and implement a thrombophilia testing protocol to reduce unnecessary and inaccurate thrombophilia testing while promoting patient safety and cost savings at the JHQVAMC.
Methodology:  A standardized note template will be created and implemented across the JHQVAMC to guide providers in the appropriate testing for thrombophilia.  Data will be reviewed before and after implementation of the standardized ordering process.  All patients diagnosed with a VTE who had thrombophilia testing completed within the last 5 years will be identified.  Data will be sourced from the corporate data warehouse (CDW), computerized patient record system (CPRS), Joint Legacy View (JLV), and pharmacy benefit management (PBM) services direct oral anticoagulant (DOAC) dashboard.  These data will be evaluated to determine if testing and follow-up were appropriately completed.  Additional endpoints include costs, duration of anticoagulation, anticoagulant choice, and misdiagnosis rate.  Thrombophilia testing practices will be evaluated among inpatient, primary care, and specialty providers.
Results: In progress
Conclusions: In progress