Impact of an integrated hospital-community care pathway on the management of venous thromboembolism: the venous thromboembolic disease care pathway 93 study.

BACKGROUND

Venous thromboembolism (VTE) carries a high risk of recurrence and bleeding complications. Care transitions represent a vulnerable period, particularly in medically underserved areas where loss to follow-up is common. Integrated hospital-community care pathways may improve outcomes, but data are limited.

OBJECTIVES

To evaluate whether an integrated hospital-community care pathway for patients with venous thromboembolism was associated with improved clinical outcomes and continuity of care compared with standard care.

METHODS

We conducted a single-center, retrospective, observational study of 161 consecutive patients managed for VTE in the day hospital at Avicenne Hospital (Bobigny, France) from December 2022 to December 2024. Patients enrolled in a structured city hospital care pathway (n = 64) were compared with those receiving standard care (n = 97). The primary endpoint was a composite of thrombotic recurrence, bleeding, hospitalization, or death. Inverse probability of treatment weighting was used to address confounding.

RESULTS

The structured pathway was associated with a lower risk of the primary composite endpoint (hazard ratio [HR], 0.44; 95% CI, 0.21-0.93; P = .03), consistent with the inverse probability of treatment weighting analysis (HR, 0.44; 95% CI, 0.21-0.92; P = .03). Loss to follow-up was markedly lower in the structured pathway group (7.8% vs 30%; P = .002), and patients lost to follow-up had a 3.5-fold higher risk of complications (HR, 3.50; 95% CI, 1.71-7.18; P < .001). Enrollment in the pathway was associated with lower odds of loss to follow-up (odds ratio, 0.21; 95% CI, 0.07-0.53; P = .002).

CONCLUSION

In this single-center, retrospective cohort study, a structured city hospital care pathway was associated with a lower risk of composite complications and a lower loss-to-follow-up rate among patients managed for VTE. These findings support the potential value of integrated care coordination pathways, particularly in medically underserved areas.