{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:52:21Z","timestamp":1785775941211,"version":"3.56.0"},"reference-count":35,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5TL1TR002549\u201004"],"award-info":[{"award-number":["5TL1TR002549\u201004"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32GM152319"],"award-info":[{"award-number":["T32GM152319"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The American Society of Hematology (ASH) recommends assessing venous thromboembolism (VTE) and major bleeding risk to optimize pharmacological VTE prophylaxis for medical inpatients. However, the clinical utility of model\u2010guided approaches remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our objective was to estimate differences in VTE and major bleeding rates and efficiency with prophylaxis guided by risk models versus clinician judgment. Patients were adults admitted to one of 10 Cleveland Clinic hospitals between December 2017 and January 2020. We compared real\u2010world practice with hypothetical prophylaxis recommended by model\u2010based strategies, including widely used risk scores (Padua &amp; IMPROVE) and locally derived Cleveland Clinic risk prediction models. For each strategy, we quantified the prophylaxis rate, VTE and major bleeding rates, and the incremental number\u2010needed\u2010to\u2010treat (NNT) to prevent one event (VTE or bleeding).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinicians prescribed prophylaxis to 62% of patients whereas model\u2010based strategies recommended prophylaxis for 17%\u201387%. Model\u2010guided prophylaxis produced more VTEs and fewer major bleeds than real\u2010world practice, but total events varied among strategies. Overall, per 1000 patients, model\u2010based strategies produced 14.0\u201316.1 events compared with 14.3 for real\u2010world practice. The Padua &amp; IMPROVE strategy minimized prophylaxis but caused the most total events. The most efficient model\u2010based strategy recommended prophylaxis to 28% of patients with an incremental NNT (relative to no prophylaxis) of 80. Compared to real\u2010world practice, it reduced prophylaxis by 55% and total events by 0.14%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinicians often prescribed inappropriate prophylaxis, highlighting the need for decision support. Model\u2010guided prophylaxis maximized efficiency by reducing prophylaxis relative to real\u2010world practice without increasing event rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70267","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T09:29:48Z","timestamp":1770370188000},"page":"845-853","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Estimated impact of model\u2010guided venous thromboembolism prophylaxis versus real\u2010world practice"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7721-5822","authenticated-orcid":false,"given":"Benjamin G","family":"Mittman","sequence":"first","affiliation":[{"name":"Medical Scientist Training Program, School of Medicine Case Western Reserve University Cleveland Ohio USA"},{"name":"Center for Value\u2010Based Care Research, Primary Care Institute Cleveland Clinic Cleveland Ohio USA"},{"name":"Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Rothberg","sequence":"additional","affiliation":[{"name":"Center for Value\u2010Based Care Research, Primary Care Institute Cleveland Clinic Cleveland Ohio USA"},{"name":"Department of Population and Quantitative Health Sciences, School of Medicine Case Western Reserve University Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.12.017"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4065\/76.11.1102"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.02196.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31828cf104"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.14.1476"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-9-201111010-00011"},{"issue":"5","key":"e_1_2_8_8_1","article-title":"Heparin for the prevention of venous thromboembolism in acutely ill medical patients (excluding stroke and myocardial infarction)","volume":"2014","author":"Alikhan R","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018022954"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2024.06.025"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000818"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0656"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3310\/AWTW6200"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-045672"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019001605"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000094"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3216"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-157-1-201207030-00450"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.04044.x"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-3081"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.9980"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH16-01-0003"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1698-6506"},{"key":"e_1_2_8_24_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2022"},{"key":"e_1_2_8_25_1","article-title":"What constitutes high risk for venous thromboembolism? 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