Journal
CIRCULATION
Volume 137, Issue 12, Pages 1278-1284Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.116.026897
Keywords
health care quality, access and evaluation; health information technology; quality indicators, health care; quality improvement; quality of health care; venous thromboembolism
Funding
- Patient-Centered Outcomes Research Institute [CE-12-11-4489]
- PCORI
- NIH/NHLBI [R21HL129028]
- National Academies of Medicine
- Agency for Healthcare Research and Quality [1R01HS024547]
- Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant
- Patient-Centered Outcomes Research Institute 1 [AD-1306-03980]
- Portola
- Janssen
- Boehringer-Ingelheim
- Roche
- Association for Professionals in Infection Control and Epidemiology, Inc.
- Agency for Healthcare Research Quality
- National Institutes of Health
- Robert Wood Johnson Foundation
- Commonwealth Fund
- AGENCY FOR HEALTHCARE RESEARCH AND QUALITY [R01HS024547] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R21HL129028] Funding Source: NIH RePORTER
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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.
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