Venous Thromboembolism Quality Measures Fail to Accurately Measure Quality

Abstract

Venous thromboembolism (VTE) is 1 of the most common causes of preventable harm for patients in hospitals. Consequently, the Joint Commission, the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, the United Kingdom Care Quality Commission, the Australian Commission on Safety and Quality in Health Care, the Maryland Health Services Cost Review Commission, and the American College of Surgeons have prioritized measuring and reporting VTE outcomes with the goal of reducing the incidence of and preventable harm from VTE. We developed a rubric for defect-free VTE prevention, graded each organizational VTE quality measure, and found that none of the current VTE-related quality measures adequately characterizes VTE prevention efforts or outcomes in hospitalized patients. Effective VTE prevention is multifactorial: clinicians must assess patients' risk for VTE and prescribe therapy appropriate for each patient's risk profile, patients must accept the prescribed therapy, and nurses must administer the therapy as prescribed. First, an ideal, defect-free VTE prevention process measure requires: (1) documentation of a standardized VTE risk assessment; (2) prescription of optimal, risk-appropriate VTE prophylaxis; and (3) administration of all risk-appropriate VTE prophylaxis as prescribed. Second, an ideal VTE outcome measure should define potentially preventable VTE as VTE that developed in patients who experienced any VTE prevention process failures.

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

“…Obesity (defined as BMI >30 kg/m 2 ) and traumatic injury are each associated with hypercoagulability and are well-known risk factors for VTE. 75 76 VTE remains a common preventable complication in critically injured patients despite being a clinical focus of multiple national agencies 77 and the existence of best practice guidelines for prophylaxis. 51 Patients with obesity have been under-represented in clinical trials of VTE prophylaxis, and recommendations for pharmacological prophylaxis in this population were not included in the American College of Chest Physicians 2012 guidelines.…”

Evaluation of Risk Factors for Venous Thromboembolism in Patients Who Underwent Gynecological Surgery and Validation of a Fast-Rating Assessment Table

“…Hemostatic agents should be used meticulously during and after operations; and in the early stage after operations, passive or active lower limb muscle exercise should be advocated. Physical methods include graded pressurized elastic socks, intermittent inflatable pressurized devices and plantar venous pumps, which have the advantage of no drug-prevented risk of bleeding [18]. Drug prevention is now dominated by low molecular weight heparin [19].…”

Effect of Real-time Patient-Centered Education Bundle on Administration of Venous Thromboembolism Prevention in Hospitalized Patients

“… 45 , 46 If we had not aimed for 0 preventable VTE events, 47 , 48 we would not have identified that doses of VTE prophylaxis were not being administered, which offered an opportunity to further reduce harm due to VTE. 10 , 13 Policy makers should ensure that the outcome and process measures are valid, 17 avoid classifying low-quality care as high-quality, and encourage curiosity about eliminating harm.…”