Factors Influencing Physician Adherence to Venous Thromboembolism Risk Assessment Model Recommendations: A Best–Worst Scaling

PURPOSE: Risk assessment models (RAM) use predictive algorithms to support physicians in personalizing care. For example, a RAM to determine the risk of venous thromboembolism (VTE-RAM) in hospitalized patients offered treatment recommendations that physicians adhered to at varying rates. We sought to investigate which factors influenced physician adherence to prophylaxis recommendations from a VTE-RAM implemented in an inpatient setting. METHODS: We assessed adherence to treatment recommendations for a VTE-RAM in the inpatient setting using both survey and real-world data sources. Inclusion criteria included being a hospitalist or resident in the inpatient setting, using a VTE-RAM at least 50 times, and having complete data from both sources available. Variation in treatment adherence from the two data sources was compared, and physicians were inductively segmented into high- and low-adherence groups. Seven possible factors influencing adherence were identified using prior research and prioritized using best-worst scaling (BWS). Results were stratified by adherence group, and differences in priorities were tested using Wald tests. RESULTS: We obtained data for 188 physicians, most of whom (56%) were unable to accurately state their rate of adherence. Two groups were identified: those with relatively high adherence (≥ 70%; n = 58) and those with relatively low adherence (< 70%; n = 130). High-adherence physicians prioritized that the VTE-RAM increases decision-making confidence (p < 0.001), reduces overtreatment of low-risk patients (p < 0.001), and facilitates documentation of low-risk patients (p = 0.029). Low-adherence physicians were more likely to prioritize that important risk factors are missing from the algorithm (p < 0.001), that the VTE-RAM disrupts workflow (p < 0.001), and that it is used owing to institutional policy requirements (p = 0.021). CONCLUSIONS: Observed physician adherence to VTE-RAM recommendations often differs from self-reported behavior. We found that several factors associated with high- and low-adherence physicians. High adherence was linked to confidence, reduced overtreatment, and documentation support, while low adherence reflected concerns about missing factors, workflow disruption, and institutional requirements. Aligning RAM design with physician priorities may improve adherence and clinical utility.