Context: Although recent trials have demonstrated the safety and efficacy of low-molecular-weight (LMW) heparin, clinicians may need help incorporating this drug into routine practice.
Objective: To describe the development, implementation, and early results of an outpatient LMW heparin program for acute deep venous thrombosis (DVT).
Design: Before-after study.
Setting: Eight health centers of Harvard Vanguard Medical Associates, a multispecialty group practice in Boston.
Patients: Patients with confirmed acute, lower-extremity DVT before (40 patients given a diagnosis from January to August 1996) and after (67 patients given a diagnosis from September 1996 to April 1997) implementation of the LMW heparin program.
Intervention: A centrally coordinated outpatient LMW heparin program.
Data sources: Hospital and HMO financial databases; electronic patient medical records.
Outcome measures: Costs of care for 2-week episodes and short-term clinical outcomes.
Results: The proportion of patients with DVT treated in the hospital decreased from 90% to 46% after the introduction of the LMW heparin program. The mean cost of treatment for all patients with DVT decreased from $5465 to $3719 per patient. For the subset of patients actually treated in the outpatient program, the average cost was $1402 per patient. There were no deaths, no clinically recognized pulmonary emboli, and no cases of significant bleeding among patients treated in the program, although 3 patients were subsequently hospitalized for worsening leg pain.
Conclusions: The cost of caring for patients with DVT decreased after introduction of the outpatient LMW heparin program. Given explicit selection criteria, short-term clinical outcomes after outpatient management have been excellent. This program may serve as a model for physicians and health plans interested in establishing a program for treating acute DVT in the outpatient setting.