Can patient education improve care and outcomes? What do patients want? They want to learn about their disease. We're going to talk about venous thromboembolism prevention today and how educating hospitalized patients about VTE prophylaxis can make a difference in their prophylaxis and their prevention for these deadly blood clots. So, we created patient education materials based on exactly what they told us. We actually surveyed and got data back from literally hundreds of patients and their family members. They told us they wanted a two-page form about blood clot prevention. And so what did we do? We created that. We took our expertise and knowledge as nurses, physicians, pharmacists and created the information, brought it back to patients, vetted it with patients, made changes in an iterative process and created a two-page front-back education form about how do I prevent blood clots that we're now giving out and using in our education materials. It's easy to find so we built it at Johns Hopkins. And if you're within the Johns Hopkins policies online website, you can very easily find the information that we've built, whether you search for VTE, DVT, PE or blood clots. It's right there comes up at the top. We created this in multiple languages and in large font, so it's great. We have the English version, that's our default. But we also have Spanish, Portuguese, Arabic, Chinese, Korean, Russian, and Nepali versions. We also have a large print version. It's no longer two pages, obviously. It's about 15 or 16 pages. But it's translated into these languages so patients can read it in their own native language. And it is astounding how happy patients are when we give them these information in the way that they really, really want to read it. These are not just used at Johns Hopkins and our educational materials. These materials are now free and open to the public for you to use. Please go to the Armstrong website. You can download them all. Our bit.ly is bit.ly/bloodclots. You can go out there and use the materials any time you want to educate patients about prevention of blood clots while they're in the hospital. Patients also told us they wanted a video so we filmed a ten-minute video. This is a little higher quality than your average patient-education video. We hired an Oscar winning director. He literally won an Oscar in the past, not for this video which is too bad. But it is a high end video and it shows exactly what patients wanted. They wanted to hear from care providers. It's not just patients, although we have six patients, real, actual human patients who actually had DVT or PE telling their personalized stories in a non-scripted video, along with physicians and nurses telling the clinical side. Same thing, this is not a secret video. It's not that we're keeping it only for Johns Hopkins Medicine. This is out there. You can go watch it on YouTube. You can go to bit.ly/bloodclots and watch the video. This video has been watched about 30,000 times. And for certainly not viral video that's gone worldwide, but for a patient education video, we've really touched a lot of people with it. We took this video and screened it for our Johns Hopkins Hospital Patient and Family Advisory Council. And they gave us feedback. And you know what we did? We took back to the director and he changed the director's cut to the official, final cut based on the feedback from the PFAQ. And like I said, it's out there in the public domain. Feel free to go and watch it. Show it to your family. Show to your friends. Show it to your patients. And use the video. Use the education that we've built. Here's some screenshots from what it looks like. We've got a few patients giving their story. We have an example of what an ultrasound looks like so the patients have some idea about it where she went into people's homes and filmed them in their own environment rather than the sterile hospital alone. So, what did we do? We created a patient-education bundle and we used it in real time. We took a real time missed dose alert via pager. Every time a nurse would document into our electronic health record system that a patient missed the dose of VTE prophylaxis, an alert would be triggered that would go directly to a pager that one of our nurses or other team members was carrying. And then, what did we do? We took a patient engagement bundle directly at the patient when that happened. And what did that included? It included on one-on-one, face-to-face engagement with a nurse educator. It included the two-page patient education handout sheet I just showed you. And it included the 10-minute patient education video. We could hand it to the patient on an iPad that they could watch it on or they could watch it on the hospital computer or the hospital TV system, where it was programmed into, so they could watch the 10-minute patient education video. This was our intervention for quality improvement. And we did a study on this. It was a prospective cohort study. It was controlled before-after intervention at our one hospital. We had a pre-intervention period and then a during the intervention period. We looked at data from 16 adult nursing units. These are medical-surgical units. We had four floors, two surgical, two medical that were intervention floors and 12 service controls. We compared the data on the intervention floors versus the control floors, and we compared to the before versus after. And here's what the data looked like. What impact did we have on missed doses? As you can see in the pre-intervention period, there was a little difference between the intervention control floor. But if you compare the pre versus post, the control floor basically, stays exactly the same, 13.6 versus 13.3. On the intervention floor, the proportion of doses that are missed went from 9.1 percent to 5.6 percent. And the odds ratio decreased by 43 percent. Dramatic reduction in the odds of missing doses but only on the intervention floor where we're making the change. The control floor basically stay the same. And where's the action? The action is on the refused doses. As you can see, this is set up the same way. The control floors, there's no difference in the proportion of doses that are refused. However, on the intervention floors, there is a dramatic drop by nearly 50 percent of the odds of refused doses. We're making a huge difference on refused doses and overall doses based on this real time alert and patient education for VTE prevention. In summary, the intervention actually worked. We weren't surprised it worked but I was truly surprised at the magnitude of effect, of the huge change that it had. It was a very large effect size and made a really big difference on missed doses of VTE prophylaxis on hospitalized patients. What's the generalizability of this? I don't know the answer yet but we hope to answer that soon. We're planning to scale this intervention. We've begun the work here at Johns Hopkins Hospital to scale it up throughout the rest of the hospital as well as to one of the other hospitals in our health system. And I do appreciate the funding from PCORI through their dissemination and implementation award for doing this work of implementation.