The Need to Revisit VTE Quality Measures

Kinnier, Christine V.; Barnard, Cindy; Bilimoria, Karl Y.

doi:10.1001/jama.2014.1841

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…Although controversial, VTE detected by administrative data are being used to assess hospital quality[13]. The PSI-12 is used as a measure for pay-for-performance for post-operative VTE.…”

Section: Discussionmentioning

confidence: 99%

Improving accuracy of International Classification of Diseases codes for venous thromboembolism in administrative data

Sanfilippo¹,

Wang²,

Gage³

et al. 2015

Thrombosis Research

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BACKGROUND Increasingly, clinicians and researchers are using administrative data for clinical and outcomes research. However, they continue to question the accuracy of using International Classification of Diseases 9th Revision (ICD-9) codes alone to capture diagnoses, especially venous thromboembolism (VTE), in administrative data. OBJECTIVES We tested the hypothesis that incorporation of treatment data and/or common procedural terminology (CPT) codes could improve accuracy of administrative data in detecting VTE. RESEARCH DESIGN Using the Veterans Affairs Central Cancer Registry, we compared three competing algorithms by performing three cross-sectional studies. Algorithm 1 identified patients by ICD-9 codes alone. Algorithm 2 required VTE treatment in addition to ICD-9 codes. Algorithm 3 required a VTE diagnostic CPT code in addition to treatment and ICD-9 criteria. RESULTS The accuracy of ICD-9 codes alone for detection of VTE was marginal, with a PPV of 72%. The PPV was improved to 91% after addition of treatment data (algorithm 2). As compared to algorithm 2, addition of CPT codes (algorithm 3) did not significantly increase the accuracy of detecting VTE (PPV 92%), but decreased sensitivity from 72% to 67%. CONCLUSIONS Accuracy of VTE detection significantly improved with addition of treatment data to ICD-9 codes. This approach should facilitate use of administrative data to assess the incidence, epidemiology, and outcomes of VTE.

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“…Although controversial, VTE detected by administrative data are being used to assess hospital quality[13]. The PSI-12 is used as a measure for pay-for-performance for post-operative VTE.…”

Section: Discussionmentioning

confidence: 99%

Improving accuracy of International Classification of Diseases codes for venous thromboembolism in administrative data

Sanfilippo¹,

Wang²,

Gage³

et al. 2015

Thrombosis Research

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“…Hospital quality measures, such as the Surgical Care Improvement Project VTE-2 (SCIP-VTE-2) and Patient Safety Indicator 12 (PSI-12), publicly report postoperative VTE prophylaxis data and are part of quality-based payment initiatives. 24 Importantly, the PSI-12 does not take into account current risk-assessment paradigms, and penalizes hospitals for VTE development whether or not the patient received appropriate risk-adjusted prophylaxis. 24 Nonadherence to guidelines continues to be a significant issue, and likely contributes, at least in part, to stable or increasing incidence of in-hospital VTE.…”

Section: The Institution Of Risk Assessment In the Hospital Systemmentioning

confidence: 99%

“…24 Importantly, the PSI-12 does not take into account current risk-assessment paradigms, and penalizes hospitals for VTE development whether or not the patient received appropriate risk-adjusted prophylaxis. 24 Nonadherence to guidelines continues to be a significant issue, and likely contributes, at least in part, to stable or increasing incidence of in-hospital VTE. 22,25 Inadequate or inaccurate risk estimation has been shown to lead to poor outcomes.…”

Section: The Institution Of Risk Assessment In the Hospital Systemmentioning

confidence: 99%

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

Jacobs

Pannucci

2017

Semin Thromb Hemost

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Venous thromboembolism (VTE) is one of the most common and feared complications in surgical patients, and its prevention has been the subject of a Call to Action from the Surgeon General of the United States. Here, we review the literature on the use of risk assessment models for the stratification of surgical patients into risk groups to guide the administration of pharmacoprophylaxis. Despite some disagreement in the literature and among various guidelines, there is good evidence that risk stratification identifies a 7- to 20-fold variation in postoperative VTE risk among the overall surgical population, including patients at both low and high risk. This information is useful to providers who are making decisions about mechanical prophylaxis and pharmacoprophylaxis.

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“…More vigilant hospitals that have a lower threshold to order an imaging study may find higher occurrences of VTE, and paradoxically be deemed a poor performer. Surveillance bias and the lack of validity of the VTE outcome measurement highlighted the importance of utilizing process‐of‐care measures in assessing hospital VTE prevention efforts . Thus, when the Joint Commission enacted 6 new VTE core process‐of‐care measures on January 1, 2013 to monitor hospital performance on VTE prophylaxis administration and VTE treatment (Table ), NMH undertook a hospital‐wide quality‐improvement (QI) project utilizing the define‐measure‐analyze‐improve‐control (DMAIC) process improvement (PI) methodology to optimize their performance on these core measures as well as the Surgical Care Improvement Project (SCIP) SCIP‐VTE‐2 measure.…”

Section: Issues and Targeted Interventions By Vte Measurementioning

confidence: 99%

Evaluation of an institutional project to improve venous thromboembolism prevention

Minami

Yang

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process‐of‐care measures to ensure appropriate VTE prophylaxis to assess healthcare‐associated VTE prevention efforts. OBJECTIVE To evaluate the impact of an institution‐wide project aimed at improving hospital performance on VTE prophylaxis measures. DESIGN A retrospective observational study. SETTING NMH, an 885‐bed academic medical center in Chicago, Illinois PATIENTS Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. INTERVENTION Using the define‐measure‐analyze‐improve‐control (DMAIC) process‐improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data‐driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. MEASUREMENTS The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP‐VTE‐2 measure. RESULTS Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5% to 90.2% on medicine services, and from 94.4% to 97.6% on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7% adherence to 100%, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4% to 88.8%. CONCLUSION A systematic hospital‐wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29–S37. © 2016 Society of Hospital Medicine

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The Need to Revisit VTE Quality Measures

Cited by 9 publications

References 6 publications

Improving accuracy of International Classification of Diseases codes for venous thromboembolism in administrative data

Improving accuracy of International Classification of Diseases codes for venous thromboembolism in administrative data

Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

Evaluation of an institutional project to improve venous thromboembolism prevention

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