Emergency physician Kathleen J. Clem, MD, FACEP, is a firm believer in asking for help every now and then when it comes to patient care. That’s why she’s so proud of the recent Bristol-Meyers Squibb/Pfizer Alliance collaborative effort to improve care for patients with Venous Thromboembolism. VTE, she said, is a big problem in rural areas, and to increase awareness, improve treatment options, and ultimately save lives, it takes a village.

“I know the public is fearful of Big Pharma and its influence on physicians in how they prescribe and care for their patients,” Dr. Clem said. “This was not the case in this project. The focus was on our patients and how to get the care they need—particularly in underserved areas. And it was under the big umbrella of expert emergency physicians providing the guidance.”

The competitive grant program, “Improving the Outpatient Management of Emergency Department Patients with Venous Thromboembolism (VTE) in Rural Areas and Underserved Communities,” launched last summer and asked for projects that promote the safe outpatient management of patients diagnosed with VTE. Applicants were asked to submit projects focused on clinical program development that overcome barriers to safe and evidence-based management, disposition, and follow up of this patient population.

The three chosen institutions—Corewell Health, Icahn School of Medicine at Mount Sinai, and Oklahoma State University Center for Health Sciences—are asked to describe the proposed clinical initiative’s efficacy with outcome measures that demonstrate improved outpatient management of VTE patients, patient safety, physician satisfaction, and/or patient satisfaction.

Dr. Clem led a review board to choose the funded projects.

She said this project is crucial because of the growing challenges of patient care in certain areas of the country, and it’s not exclusively in rural settings. Although the grant project is focused on those areas, patients and physicians everywhere will benefit.

“I don’t think we have access to the testing that we need in real time across the entire country,” she said. “Having a better understanding of why it matters will increase the accessibility and timeliness. We need a timely diagnosis of the patient to determine if the clot is there or not at all. And if they have one, is it progressing? And is it something we need to be even more concerned about? It’s also crucial to get the patient into follow-up for someone who understands venous thromboembolism disease. Access is a challenge and timely follow up is difficult, even in places with high population density. More places have these challenges than ones who don’t.”

Dozens of submissions to win grant funding to combat these challenges came from across the country. Three stood out, and here are the core components of their submissions:

Corewell Health

• Tailor and implement an evidence-based PE clinical pathway that provides rural ED clinicians with clear criteria for screening PE patients for outpatient management, readily available clinical decision support tools, and a mechanism to ensure reliable expedited follow-up.
• Increase utilization of validated severity assessment tools among stable rural PE patients.
• Establish a virtual PE follow-up clinic using existing telehealth infrastructure to guarantee availability of follow-up for rural ED patients discharged with low-risk PE, proactively identify and address barriers to medication compliance, and bridge the transition back to a PCP.
• Utilize a recently established VACC to introduce a protocol-driven virtual follow up visit for PE patients within 72 hours of ED discharge to assess clinical stability, facilitate diagnostic testing, address barriers to medication compliance, and ensure subsequent PCP follow-up.
• Ensure rapid, consistent, follow-up care to PE patients discharged from rural EDs, reduce unnecessary return ED visits, eliminate interruptions in anticoagulation.

Icahn School of Medicine at Mount Sinai

• Develop and implement an interdisciplinary clinical pathway that includes an electronic medical record (EMR) order set and a discharge smart set to guide the management of low-risk VTE patients in the ED.
• Evaluate the impact of the pathway on key outcome measures, including: the reduction in admission rates for low-risk VTE patients, a decrease in ED return visit rates within 72 hours and 30 days, and an increase in the rate of initiation outpatient treatment and follow-up care, particularly for uninsured or underinsured patients.
• Enhance provider knowledge and adherence to evidence-based guidelines for the outpatient management of low-risk VTE through targeted education and clinical decision-support tools embedded within the EMR.
• Improve patient education and empowerment by developing and disseminating patient-centered educational materials that promote treatment adherence, self-management, and understanding of VTE.
• Foster collaboration and communication among interdisciplinary team members involved in the care of low-risk VTE patients, including emergency physicians, pharmacists, social workers, and case managers.

Oklahoma State University Center for Health Sciences

• Develop and implement a comprehensive training program for interdisciplinary health care workers in rural EDs to enhance their ability to manage low-risk VTE patients safely on an outpatient basis.
• Increase the knowledge and application of evidence-based VTE management guidelines among health care professionals in targeted communities.
• Identify and evaluate barriers to safe, effective outpatient VTE care for low-risk patients in rural emergency medicine, focusing on health equity.
• Establish and implement system-based changes and procedures, guided by an interdisciplinary team, for identifying and treating low-risk VTE patients eligible for outpatient care across participating rural hospital EDs.
• Integrate virtual health through telehealth into outpatient care for low-risk VTE patients to enhance post-ED care access and improve adherence to provider recommendations.

Corewell, Mount Sinai, and Oklahoma State were notified of their grant funding in October. Each proposal included a timeline for completion.

“What I appreciated—just to put it in a short sentence—they got it.” Dr. Clem said. “They understood why this mattered, and how this was going to work to improve their population of patients, not only in the here and now but as they progress in the future to improve the care of the diagnosis and treatment of patients with thromboembolic disease. I was so impressed and happy to work with our review team.”

Ms. Megan Sambell is a Quality Improvement Project Manager at ACEP.

Mr. Darrin Scheid, CAE is Communication Director at ACEP.