Preventable Harm from Venous Thromboembolism (VTE) - A New Metric for Quality of Care
Haut, Elliott R.
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Venous thromboembolism (VTE), comprised of deep venous thrombosis (DVT) and pulmonary embolism (PE), is an underappreciated public health concern. According to the United States’ Surgeon’s General “Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism,” VTE affects between 350,000-600,000 Americans each year, causing over 100,000 deaths annually. Even with overwhelming evidence of benefit, many hospitalized patients do not receive adequate VTE prophylaxis. The Agency for Healthcare Research and Quality (AHRQ) has called VTE prevention the number one strategy to improve patient safety in hospitals. As a consequence, many governmental agencies, accrediting bodies, and patient safety organizations have made improving VTE prophylaxis a priority and VTE is suggested as an ideal target for public reporting. However, VTE rates alone are not reliable as quality indicators. We suggest a more palatable and reliable measure of preventable harm from VTE. Chapter 1 shows how publicly reported VTE process and outcome measures fail to correlate and are not valid to benchmark hospitals. Chapter 2 explains how surveillance bias limits the role of VTE outcome reporting and offers a better solution- linking VTE process and outcome data into a single measure to define preventable harm. Chapter 3 summarizes published approaches to improve VTE prophylaxis for hospitalized patients. Chapter 4 offers perspectives on lessons learned while implementing a mandatory computerized clinical decision support tool to improve VTE prevention at our academic medical center. Chapters 5 and report data showing how our tool decreased preventable harm from VTE (using our definition) in adult trauma and medicine patients. Chapter 7 presents a real-world example of the feasibility of linking VTE prevention process and outcome measures. The work of this dissertation has already influenced national policy. By inclusion in The Centers for Medicare and Medicaid Services financial incentives programs for the “meaningful use” of certified electronic health record (EHR) technology to improve patient care. VTE-6 is defined as patients diagnosed with confirmed VTE who did not receive VTE prophylaxis" This definition followed our suggestion that “performance measures could link a process of care with adverse outcomes when defining incidences of preventable harm.” We posed the question; CMS now requires that all participating hospitals answer our query.