OBJECTIVES: Current data support the use of low molecular weight heparin (LMWH) in lieu of unfractionated heparin (UFH) in many patients to achieve greater clinical efficacy and pharmacoeconomic efficiency. Most hospitals have not achieved clinically effective use of LMWH and UFH in the treatment and prevention of thrombotic disorders. The Clinical Effectiveness Initiative (CEI) was designed to help hospitals achieve better data assessment to measure patient outcomes, reduce medical errors, reduce risk, and reach towards optimal financial performance in these patient groups. METHODS: CEI begins with analysis of data available from the UB-92 and pharmacy or cost-accounting systems. The actuarial analysis provides a risk-adjusted comparison of patient cohorts receiving antithrombotics (LMWH or UFH). Results are reported to the institution in a format suitable for use with performance improvement activities and physicians. The total cost for each cohort is broken down into drug acquisition costs and costs associated with laboratory tests, level of care, supplies and length of stay. RESULTS: Results completed from two hospitals in 87 DRGs that had at least 10 discharges in each drug category (5374 LMWH, 9380 UFH) showed a case mix adjusted average savings of $698 per discharge. The study to-date has showed that the use of LMWH reduced overall cost in many high-use categories, despite the higher drug acquisition cost. Those included DVT, Hip and Knee replacement cases. Findings also demonstrated an opportunity for substantial savings with greater selective use of LMWH in several cohorts that will shared in chart form. The data analysis and structured interviews with hospital leadership presented valuable insights into how best to facilitate changes in practice patterns that can be continually measured. CONCLUSIONS: We conclude that the data assessment and efficiency modeling capabilities of CEI are powerful tools to help hospitals achieve clinical effectiveness, especially when integrated into a hospital's performance improvement program.