Advanced practice provider–led clinic for care transitions in newly diagnosed venous thromboembolism: establishment and utilization

• Published in: Research and practice in thrombosis and haemostasis Vol. 7; no. 4; p. 100198
• Main Authors: Frank, Cassiopeia, Kasthuri, Raj, Key, Nigel S., Mooberry, Micah, Wilson, Samuel R., Moll, Stephan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023; Elsevier
• Subjects: advanced practice provider; anticoagulants; Brief Report; care transition; thrombosis; venous thromboembolism; care transition; anticoagulants; advanced practice provider; thrombosis; venous thromboembolism
• ISSN: 2475-0379; 2475-0379
• DOI: 10.1016/j.rpth.2023.100198

Patients with suspected or newly diagnosed venous thromboembolism (VTE) are often referred to the emergency department (ED) for management, where anticoagulation is initiated. However, when the patient is judged to be suitable for outpatient management, counseling and follow-up specialty care are frequently suboptimal. To establish an advanced practice provider (APP)–led rapid follow-up clinic to improve transitions of care for patients with newly diagnosed deep vein thrombosis or low-risk pulmonary embolism and to provide continued specialty care and support, including management of complications and medication access issues. In order to address this gap in transition of care, we developed an APP-led clinic with a mandate to improve quality and safety in the outpatient setting for patients with acute VTE. In the first 2 years, a total of 234 patients were evaluated, of whom data were standardized and reviewed for 229. Utilization steadily increased over time, with at least 10% of patients requiring financial medication assistance over both years. Seventy-two percent of patients were referred from the ED in the first year and 59% in the second year, and referrals from non-ED outpatient specialties increased. Data on deviations from standard care identified in referred patients were collected in the second year and found in 19 (12.7%) of cases. These included unnecessarily prescribed or changed anticoagulants, dosing errors, misclassification of thrombosis, and other deviations. Patient demographic data also demonstrated increasing diversity of the patient population over time, with increased utilization by Hispanic and African American patients in the second year. This highlighted the need for better patient education material translations into Spanish, which is a future aim. In summary, the APP-led VTE Transition Clinic was feasible and grew quickly in utilization, diversity of referrals, and diversity of patients served. •There is a need for transitions of care in patients with newly diagnosed venous thromboembolism.•An advanced practice provider–led clinic was designed to address this need at University of North Carolina Health.•Utilization of the care transitions clinic grew over time, serving >200 patients in 2 years.•The established model was feasible and evolved to serve increasingly diverse referral sources.