Development of a Novel Composite Process Measure for Venous Thromboembolism Prophylaxis

Kinnier, Christine V.; Ju, Mila H.; Kmiecik, Thomas E.; Barnard, Cindy; Halverson, Terri; Yang, Anthony D.; Caprini, Joseph A.; Kreutzer, Lindsey; Bilimoria, Karl Y.

doi:10.1097/mlr.0000000000000474

Cited by 21 publications

(15 citation statements)

References 29 publications

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“…Other designs included mixed, cross-sectional, and qualitative methods. Among the studies that developed, used, or studied outcome measure sets, 20 studies validated these outcomes in clinical practice [ 39 – 41 , 43 , 44 , 46 – 54 , 60 , 63 , 65 – 67 , 69 ].…”

Section: Resultsmentioning

confidence: 99%

“…As Quality of Life (QoL) is evaluated and reported by patients and includes measures that are relatively visible, their inclusion in the outcome sets of VBHC was very common, particularly in this theme ( n = 24) [ 40 , 41 , 43 , 44 , 46 , 52 , 53 , 56 – 59 , 61 – 66 , 70 – 76 ]. To ensure the inclusion of outcomes that the patients value most, the studies used a combination of generic and disease/condition-specific tools to measure QoL that covered multiple domains such as mental, functional, social, physical, and other aspects of health status.…”

Section: Resultsmentioning

confidence: 99%

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Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

Abdalla

Pavlova

Hussein

et al. 2022

BMC Health Serv Res

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Background This systematic literature review identifies hospital value-based healthcare quality measures, measurement practices, and tools, as well as potential strategies for improving cardiovascular diseases and cancer care. Methods A systematic search was carried out in the PubMed, Embase, CINAHL, and MEDLINE (OvidSP) databases. We included studies on quality measures in hospital value-based healthcare for cardiovascular diseases and cancer. Two reviewers independently screened titles and abstracts, conducted a full-text review of potentially relevant articles, assessed the quality of included studies, and extracted data thematically. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and four validated tools were used for methodological quality assessment. Results The search yielded 2860 publications. After screening the titles and abstracts, 60 articles were retrieved for full-text review. A total of 37 studies met our inclusion criteria. We found that standardized outcome sets with patient involvement were developed for some cardiovascular diseases and cancer. Despite the heterogeneity in outcome measures, there was consensus to include clinical outcomes on survival rate and disease control, disutility of care, and patient-reported outcome measures such as long-term quality of life. Conclusion Hospitals that developed value-based healthcare or are planning to do so can choose whether they prefer to implement the standardized outcomes step-by-step, collect additional measures, or develop their own set of measures. However, they need to ensure that their performance can be consistently compared to that of their peers and that they measure what prioritizes and maximizes value for their patients. Trial registration PROSPERO ID: CRD42021229763.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

Abdalla

Pavlova

Hussein

et al. 2022

BMC Health Serv Res

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“…However, Surgical Care Improvement Project (SCIP) guidelines that were implemented in 2008 require the use of VTE prophylaxis or documentation of why prophylaxis was not provided (15). We assume that the compliance with these guidelines was very high (>95%) due to the penalties imposed on hospitals and thus, the majority of the patients in this cohort likely received VTE prophylaxis (16). …”

Section: Methodsmentioning

confidence: 99%

The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients

Barber

Clarke‐Pearson

2016

American Journal of Obstetrics and Gynecology

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BACKGROUND Use of risk assessment tools, such as the Caprini score or Rogers score, is recommended by national societies to stratify surgical patients by venous thromboembolism (VTE) risk and guide prophylaxis. However, these tools were not developed in a gynecologic oncology patient population and their utility in this population is unknown. OBJECTIVE To examine the ability of both the Caprini and Rogers score to stratify gynecologic oncology patients by risk of VTE. STUDY DESIGN Patients undergoing surgery for cervical, ovarian, uterine, vaginal and vulvar cancers between 2008 and 2013 were identified from the National Surgical Quality Improvement Database using ICD-9 codes. Caprini and Rogers scores were calculated for each patient based upon recorded demographic and procedure data. VTE events were recorded for 30 days postoperatively. Patients were categorized into risk groups based on calculated Caprini and Rogers scores and the incidence of VTE and 95% confidence interval was estimated for each of these groups. The relationship between risk score and VTE incidence was examined with Pearson’s correlation coefficient. RESULTS Of 17,713 patients, 1.8% developed a VTE. No patients were classified by the Caprini score as low risk, 0.1% were moderate risk, 3.0% were higher risk (score 4), and 96.9% were highest risk (score >=5). The Caprini score groupings did not correlate with VTE. The high-risk group had a paradoxically higher incidence of VTE of 2.5% compared to the highest risk group, 1.7% (p=0.40). However, when the highest risk group of the Caprini score was sub-stratified, it was highly correlated with VTE (R2=0.93). For the Rogers score, only 0.2% of patients were low risk (score <7), 36.9% were medium risk (score 7–10), and 63.0% were high-risk (score >10). When the highest risk group of the Rogers score was sub-stratified, it was also highly correlated with VTE (R2=0.99). CONCLUSIONS Gynecologic oncology patients score very high on current VTE risk assessment models. The Caprini score is limited in its ability to discriminate relative VTE risk among gynecologic oncology patients as 97% are in the highest-risk category. Sub-stratification of the highest risk groups allows for relative VTE risk stratification among gynecologic oncology patients suggesting that further evaluation of risk stratification is needed in gynecologic oncology surgery.

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“…Data from our institution provided evidence that while ambulation and SCD component measure adherence is high, chemoprophylaxis adherence required significant improvement. 10 When chemoprophylaxis process measure adherence data were analyzed further, a major failure mode was patient refusal of one or more doses. However, the drivers of patient refusal are not well defined in the literature, and previous studies have called for a greater focus on developing interventions to improve VTE chemoprophylaxis administration.…”

mentioning

confidence: 99%

“…3,5 Given the inadequacy of current VTE-related quality measures to identify actionable failures in the provision of VTE prophylaxis, our group created a VTE process-of-care measure to assess adherence to the components of VTE prophylaxis: (1) early ambulation, (2) mechanical prophylaxis (sequential compression devices [SCDs]), and (3) chemoprophylaxis administered at the correct dose and frequency for the duration of the patient's hospital stay. 3,10,11 This quality measure was conceived, created, and iteratively revised to measure whether optimal care is provided to patients throughout their hospitalization and identify actionable areas in which failures of care occur, in order to decrease the risk of a VTE event. Data from our institution provided evidence that while ambulation and SCD component measure adherence is high, chemoprophylaxis adherence required significant improvement.…”

mentioning

confidence: 99%

Barriers to Providing VTE Chemoprophylaxis to Hospitalized Patients: A Nursing‐Focused Qualitative Evaluation

Kreutzer¹,

Yang²,

Sansone³

et al. 2019

Journal of Hospital Medicine

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BACKGROUND: Venous thromboembolism (VTE) is a serious medical condition that results in preventable morbidity and mortality. OBJECTIVES: The objective of this study was to identify nursing-related barriers to administration of VTE chemoprophylaxis to hospitalized patients. DESIGN: This was a qualitative study including nurses from five inpatient units at one hospital. METHODS: Observations were conducted on five units to gain insight into the process for administering chemoprophylaxis. Focus group interviews were conducted with nurses and were audio-recorded, transcribed verbatim, and analyzed using the Theoretical Domains Framework to identify barriers to providing VTE chemoprophylaxis. RESULTS: We conducted 14 focus group interviews with nurses from five inpatient units to assess nurses’ perceptions of barriers to administration of VTE chemoprophylaxis. The barriers identified included nurses’ misconceptions that ambulating patients did not require chemoprophylaxis, nurses’ uncertainty when counseling patients on the importance of chemoprophylaxis, and a lack of comparative data for nurses regarding their specific refusal rates. CONCLUSIONS: Multiple factors act as barriers to patients receiving VTE chemoprophylaxis. These barriers are often modifiable targets for quality improvement. There is a need to focus on behavior changes that will remove or minimize barriers and equip nurses to ensure administration of VTE chemoprophylaxis by engaging patients in their care.

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Development of a Novel Composite Process Measure for Venous Thromboembolism Prophylaxis

Abstract: This new measure incorporates the critical aspects of VTE prevention to ensure defect-free care. After additional evaluation, this composite VTE prophylaxis measure with appropriate exclusion criteria may be a better alternative to existing VTE process and outcome measures.

Cited by 21 publications

References 29 publications

Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

Quality measurement for cardiovascular diseases and cancer in hospital value-based healthcare: a systematic review of the literature

The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients

Barriers to Providing VTE Chemoprophylaxis to Hospitalized Patients: A Nursing‐Focused Qualitative Evaluation

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