Additional Reflections on Preventing Venous Thromboembolism

• 10/29/2009
• Author: Steven Berman
• Category: The Journal Blog
• 20454 Views
• 0 Comments
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This week, Alpesh Amin, author (with Steven Deitelzweig) of “Optimizing the Prevention of Venous Thromboembolism: Recent Quality Initiatives and Strategies to Drive Improvement,” which published in the November 2009 issue, guests on the blog. In the article, they review the quality indicators, public reporting initiatives, incentive programs, and “negative reimbursement” that are designed to help hospitals improve venous thromboembolism (VTE) prevention. In this blog, Dr. Amin reflects on some recent developments since writing the article. The Journal welcomes your comments. What quality initiatives and strategies have you found helpful in optimizing VTE prevention practices? 

As a serious, treatable complication, deep venous thrombosis (DVT/VTE) has been added as a Centers for Medicare & Medicaid Services (CMS) nursing- sensitive measure, failure to rescue—which highlights the importance of accountability of every member of the health care team in achieving quality outcomes. Readmission rates are emerging as another important issue. Patients who had a hospital-acquired VTE are likely to be readmitted over one third of the time. A Niagara Health Quality Coalition analysis suggests that there are 87,000 potentially preventable readmissions with VTE within 30 days in the Medicare population (http://www.myhealthfinder.com/cmsletter063009.pdf). 
 
The Leapfrog Group hospitals were asked in March 2008 to sign an agreement to not bill for “never events.” States have implemented legislation to require reporting of events, and California has imposed fines for occurrence of “never events” in 2007. Medicare is working on not making additional payment for DVT or pulmonary embolism that develops during the hospital stay.
 
Finally, the continuum of care is important to achieve quality of care. As we stated in the article, National Quality Forum Safe Practice 28 recommends that each patient be evaluated, and periodically thereafter, for the risk of developing VTE. It also recommends that evidence-based methods of appropriate thromboprophylaxis be used if required. One important point is that the concept of ensuring assessment “periodically thereafter” reflects the fact that patient status changes during the hospitalization and after, and so does one’s risk for VTE. For example, renal function and procedure-based mobility changes during the hospitalization could affect approaches to VTE prevention. Our practice must be more continuous and longitudinal in terms of assessment and use of evidence-based practices to ensure the highest-possible quality outcomes for our patients.