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Background Venous thromboembolism (VTE) causes preventable in-hospital morbidity. Pharmacologic prophylaxis reduces VTE in at-risk patients but also increases bleeding. To increase appropriate prescribing, a risk calculator to guide prophylaxis decisions was developed. Despite efforts to promote its use, providers accessed it infrequently. Objective This study aimed to understand provider perspectives on VTE prophylaxis and facilitators and barriers to using the risk calculator. Design This is a qualitative study exploring provider perspectives on VTE prophylaxis and the VTE risk calculator. Participants We interviewed attending physicians and advanced practice providers who used the calculator, and site champions who promoted calculator use. Providers were categorized by real-world usage over a 3-month period: low (50%). Approach During semistructured interviews, we asked about experiences with VTE, calculator use, perspectives on its implementation, and experiences with other risk assessment tools. Once thematic saturation was reached, transcripts were analyzed using content analysis to identify themes. Results Fourteen providers participated. Five were high utilizers, three were moderate utilizers, and six were low utilizers. Three site champions participated. Eight major themes were identified as follows: (1) ease of use, (2) perception of VTE risk, (3) harms of thromboprophylaxis, (4) overestimation of calculator use, (5) confidence in own ability, (6) underestimation of risk by calculator, (7) variability of trust in calculator, and (8) validation to withhold prophylaxis from low-risk patients. Conclusions While providers found the calculator is easy to use, routine use may be hindered by distrust of its recommendations. Inaccurate perception of VTE and bleeding risk may prevent calculator use.

Supplemental material, sj-docx-1-mdm-10.1177_0272989X221121350 for Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation by Kathryn A. Martinez, Debra T. Linfield, Victoria Shaker and Michael B. Rothberg in Medical Decision Making

Additional file 1.

Supplemental material, sj-docx-1-mdm-10.1177_0272989X221121350 for Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation by Kathryn A. Martinez, Debra T. Linfield, Victoria Shaker and Michael B. Rothberg in Medical Decision Making

Acute kidney injury (AKI) is common among hospitalized patients with community-acquired pneumonia (CAP). We aimed to estimate and compare the risk of AKI for various antibiotic combinations in adults hospitalized for CAP. We conducted a retrospective cohort study of the Premier Healthcare Database containing all admissions for 660 US hospitals from 2010 to 2015. We included adults aged ���18 years hospitalized with CAP and considered 6 different antibiotic combinations based on continuous use in the first 3 hospital days. The primary outcome was incident AKI, defined by ICD-9 codes 584.5-584-9. We evaluated associations of AKI with in-hospital mortality and length-of-stay. We excluded patients who were admitted directly to the intensive care unit, had AKI codes present on admission or had dialysis in the first 2 days. We used generalized linear mixed models with the hospital as a random effect and covariate adjustment for patient demographics, comorbidities, other treatments on day 0/1, and hospital characteristics. The total sample included 449,535 patients, 3.15% of whom developed AKI. All other regimens but fluoroquinolones exhibited higher AKI odds than 3rd generation cephalosporin with or without macrolide. The combination of piperacillin/tazobactam and vancomycin with or without other antibiotics was associated with the highest AKI odds (OR = 1.89; 95% CI: 1.73���2.06). Patients with incident AKI had an increased odds of hospital mortality (OR = 6.37; 95% CI: 6.07���6.69) and longer length-of-stay (mean multiplier = 1.84; 95% CI: 1.82, 1.86). Compared to 3rd generation cephalosporin with or without macrolide, piperacillin/tazobactam, vancomycin, and their combination were associated with higher odds of developing AKI, which in turn were associated with worse clinical outcomes.

Supplemental material, Appendix_MDM-19-501-R1_8-4-2020_online_supp for Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research by Glen B. Taksler, Jarrod E. Dalton, Adam T. Perzynski, Michael B. Rothberg, Alex Milinovich, Nikolas I. Krieger, Neal V. Dawson, Mary J. Roach and Douglas Einstadter in Medical Decision Making

Supplemental material, Appendix_1_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice

Supplemental material, Appendix_4_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice

Supplemental material, Appendix_3_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice

Supplemental material, Appendix_2_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice

Supplemental material, Appendix_1_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice

Supplemental material, Appendix_4_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice

Supplemental material, Appendix_3_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice

Supplemental material, Appendix_2_online_supp for Assessing Patient Interest in Individualized Preventive Care Recommendations by Glen B. Taksler, Mary Beth Mercer, Angela Fagerlin and Michael B. Rothberg in MDM Policy & Practice