Community DVT Form Test Page

The National Blood Clot Alliance® (NBCA) Centers of Excellence (COE) program is committed to improving the care of patients with venous thromboembolic (VTE) disease through collaboration between clinical specialists, patients, and communities. The program aims to raise awareness of VTE disease and establish a network of endorsed institutions and organizations dedicated to patient-centered care and providing top-notch care for their communities. The NBCA Community DVT COE program is a key component of this initiative, emphasizing the importance of delivering specialized DVT care at the community level.

Thank you for your interest in the NBCA Community DVT Center of Excellence™ program. NBCA wants to learn as much as possible about your DVT program and how it aligns with the goals of the Community DVT COE initiative. Please complete the questionnaire with explanations you feel might be helpful to provide additional clarifying information. NBCA recognizes that most centers will not have all the elements listed under each section, but the Center of Excellence Committee will use the provided information to gain as complete assessment of each program as possible for consideration of a COE designation. NBCA will also provide feedback as to opportunities for growth and improvement based on its work and experience with other programs.

Together, we can Stop the Clot®.

The application process for the NBCA Center of Excellence designation is designed to thoroughly evaluate all aspects of your program. There are 7 banks of questions, each focusing on specific criteria that the NBCA considers essential for a Center of Excellence. Supporting documentation that must be uploaded is included below. We recommend printing the instructions for your reference as you complete the application. Please follow these instructions carefully to ensure a complete and accurate submission:

1. Review Each Bank of Questions:

• Each bank represents different criteria related to clinical excellence, program structure, and best practices for venous thromboembolism (VTE) care.
• Review each question/statement and evaluate how your program aligns with the criteria.

2. Select the Most Applicable Response:

• For each statement, check the box next to the option that best reflects the current state of your program.
• You must select at least one response.
• Be honest and realistic in your assessment, as this helps the NBCA understand where your program currently stands and how it may develop further.
• You may navigate throughout the application completing sections based on information available. Following hitting the submit button, if any required fields are missing, the application will bring you back to those fields for completion prior to the form being submitted.

3. Provide Additional Comments:

• Under each statement, there is a comment box. Use this space to:
  • Provide any further explanation or clarification of your program's status.
  • Share information regarding future plans, ongoing initiatives, or any efforts in progress to meet the criteria.
  • Highlight specific program strengths or challenges.

4. Upload Supporting Documentation:

• Required documentation:
• Letter of recommendation from a provider and/or administrator associated with your VTE program endorsing the COE designation.
• Example of patient feedback regarding the VTE program such as:
  1. Patient comments shared with the center.
  2. Letter from VTE patient endorsing program and/or COE designation.
  3. Communication from a patient regarding VTE care/center.
• Two deidentified case reports of DVT patients including timeline when key elements of care were provided (including but not limited to time of presentation, time of diagnosis, initiation of anticoagulation, if referral completed, follow up)
1. Community DVT COE applicants should submit 2 DVT case reports.
• If applicable, upload any supporting evidence for the information provided in the associated drop box. This should include:
• Program protocols, policies, algorithms, dedicated VTE order sets, or guidelines used in your institution.
• Patient outcomes data, performance/quality metrics, or dashboards.
• Educational materials, training documentation, or discharge instructions.
• Acceptable forms of documentation may include documents, screen shots, or photos of the requested materials.
• Ensure that all uploaded documents are clearly labeled.

5. Complete NBCA VTE team contact information:

• This information will be for internal use at NBCA to ensure we are able to appropriately communicate with teams at your institution to ensure a timely review of materials, coordination for site visits, and designation follow-up and event planning.

6. Complete Post Application Survey

• Thank you in advance for providing critical feedback on our application and review process which will help us evolve and optimize this process for future COE applicants.

7. Submit Completed Application:

• Review all sections to confirm that you have responded to each bank of questions, provided comments where necessary, and uploaded supporting documents.
• Ensure all information is accurate and up-to-date.
• You must complete all 3 forms (application, team contact form, and survey) prior to submitting.
• Once you are satisfied with your responses, submit the application through the NBCA’s online portal.

If you have any questions or need clarification during the application process, please reach out to NBCAVTECOE@stoptheclot.org for assistance. We look forward to reviewing your submission!

Thank you for your time and valuable feedback! Your responses will help us improve the application process for future applicants and continue to enhance the NBCA Center of Excellence program.

You have completed the Community DVT Center of Excellence Program Formal Application. Clicking submit will finalize your application, and you will not be able to make any edits. If you still need to make changes, we recommend selecting 'Save and Continue Later' before submitting.