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Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT)

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Abstract

PERTs are a new, multidisciplinary approach to PE care. They were conceived to efficiently identify and risk stratify PE patients and standardize care delivery. More research needs to be conducted to assess the effects that PERTs have had on PE care. This study sought to determine the effects of a PERT on quality and overall value of care. This was a retrospective study of all patients 18 years of age or older who presented with a principal diagnosis of an acute PE based on available ICD codes from January 1, 2010 to December 31, 2018. Patients who did not have an imaging study, i.e., CTPA or ECHO, available were excluded. Patients were divided into pre- (before October 2015) and post-PERT eras (after October 2015) and stratified based on the presence of right heart strain/dysfunction on imaging. All quality outcomes were extracted from the EMR, and cost outcomes were provided by the financial department. 530 individuals (226 pre-PERT and 304 post-PERT) were identified for analysis. Quality outcomes improved between the eras; most notably in-hospital mortality decreased (16.5 vs. 9.6) and hospital LOS decreased (7.7 vs. 4.4) (p < 0.05). Total cost of care also decreased a statistically significant amount between the eras. The implementation of a PERT improved quality and cost of care, resulting in improved value. We hypothesize that this may be due to more timely identification and risk stratification leading to earlier interventions and streamlined decision making, but further research is required to validate these findings in larger cohorts.

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Data availability

Since the data collected is considered PHI, the authors alone have custody over it, per the agreement made with the IRB. However, deidentified data can made accessible upon request.

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Funding

Rahul Annabathula was supported by a 2019 AOA Carolyn L. Kuckein Student Research Fellowship. The project described was supported by the NIH National Center for Advancing Translational Sciences through Grant Number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. College of Medicine, University of Kentucky, Lexington, KY, USA

    Rahul Annabathula

  2. Department of Biostatistics, University of Kentucky, Lexington, KY, USA

    Adam Dugan

  3. Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, 900 S. Limestone, CTW 320, Lexington, KY, 40536, USA

    Vikas Bhalla, Susan S. Smyth & Vedant A. Gupta

  4. Antithrombosis Stewardship, UK HealthCare, University of Kentucky, Lexington, KY, USA

    George A. Davis

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  1. Rahul Annabathula
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  2. Adam Dugan
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  3. Vikas Bhalla
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  4. George A. Davis
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  5. Susan S. Smyth
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  6. Vedant A. Gupta
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Contributions

VG, the corresponding author, takes responsibility for the content of this manuscript, including all data and analyses. RA helped draft the initial project and gathered the data and, along with VG, wrote much of the manuscript. AD, VB, GD, and SS contributed substantially to the study design, data analysis, and interpretation.

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Correspondence to Vedant A. Gupta.

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Annabathula, R., Dugan, A., Bhalla, V. et al. Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT). J Thromb Thrombolysis 51, 217–225 (2021). https://doi.org/10.1007/s11239-020-02188-3

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  • DOI: https://doi.org/10.1007/s11239-020-02188-3

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