eMeasure Title Incidence of Potentially-Preventable Venous Thromboembolism
eMeasure Identifier
(Measure Authoring Tool)
114 eMeasure Version number 2
NQF Number 0376 GUID 32cfc834-843a-4f45-b359-8e158eac4396
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Joint Commission
Measure Developer Joint Commission
Endorsed By National Quality Forum
Description
This measure assesses the number of patients diagnosed with confirmed VTE during hospitalization (not present at admission) who did not receive VTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date.
Copyright
Measure specifications are in the Public Domain.

LOINC(R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-–2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
None
Measure Scoring Proportion
Measure Type Outcome
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The concept of “failure to prevent” has generated interest in national health policy organizations to identify evidence-based practice that will improve patient safety in the hospital setting. In spite of formal guidelines, pulmonary embolism is the most common preventable cause of death among hospitalized patients, causing or contributing to 5% to 10% of all in-hospital deaths. A study at a large teaching hospital found that potentially preventable cases of VTE represented two-thirds of all VTE cases where prophylaxis was indicated, with 47.7% due to failure to give any prophylaxis, 22.7% because of inadequate duration or 20% due to incorrect type of prophylaxis. Almost one-half of all VTEs occurring in the community are related to recent hospitalization, either for major surgery or for acute medical illness.
Gillies and colleagues identified three groups of surgical patients less likely to receive prophylaxis: moderate-risk patients, emergency admission, and conservatively treated patients. Failure to prevent VTE can result in delayed hospital discharge or readmission, increased risk for long-term morbidity from post-thrombotic syndrome, and recurrent thrombosis in the future.
Clinical Recommendation Statement
Failure to prevent VTE can result in delayed hospital discharge or readmission, increased risk for long-term mobidity from post-thrombotic syndrome, and recurrent thrombosis in the future.
Improvement Notation
A decrease in the rate
Reference
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest 2008; 133:381S-453S
Reference
Baglin TP, White K, Charles A. Fatal pulmonary embolism in hospitalized medical patients. J Clin Pathol. 1997 Jul;50(7):609-10.
Reference
Arnold DM, Kahn SR, Shrier I. Missed opportunities for prevention of venous thromboembolism: an evaluation of the use of thromboprophylaxis guidelines. Chest. 2001 Dec;120(6):1964-71.
Reference
Heit JA, O'Fallon WM, Petterson TM et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002 Jun 10;162(11):1245-8.
Reference
Gillies TE, Ruckley CV, Nixon SJ. Still missing the boat with fatal pulmonary embolism. Br J Surg. 1996 Oct;83(10):1394-5.
Definition
None
Guidance
The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

The facility location arrival datetime and facility location departure datetime are coupled with the emergency department visit value set. They intend to represent arrival date/time at the emergency department and the discharge date/time from the emergency department, respectively.

When unfractionated heparin is not administered due to medical reasons, the intended administration route is subcutaneous.
Transmission Format
None
Initial Patient Population
Patients admitted to the hospital for inpatient acute care with no principal diagnosis code for venous thromboembolism (VTE), with at least one other diagnosis code for venous thromboembolism (VTE) with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission.
Denominator
Patients who developed VTE confirmed by a diagnostic test during hospitalization.
Denominator Exclusions
Patients with comfort measures only documented
Patients with a principal diagnosis of VTE
Patients with VTE present at admission
Patients with reasons for not administering mechanical and pharmacologic prophylaxis
Numerator
Patients who received no VTE prophylaxis prior to the VTE diagnostic test order date.
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
eMeasure Venous Thromboembolism (eVTE)