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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Venous Thromboembolism Outcome-only Quality Measures Fail to Provide Actionable Information about Prevention Practices Brandyn D.Lau1, 2, 3, 4, Michael B.Streiff1, 2, Dauryne L.Shaffer5, Peggy S.Kraus5, Elliott R.Haut1, 2, 3, 4. 1Johns Hopkins School of Medicine, Baltimore, MD, USA.2Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA.3Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.4Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.5Johns Hopkins Hospital, Baltimore, MD, USA |
Abstract
Background: Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and occurs frequently among hospitalized patients. The overwhelming evidence supporting VTE prophylaxis and remarkable success of interventions to increase its use in hospitals led the Agency for Healthcare Research and Quality to endorse practices to prevent VTE as one of the top 10 strategies to improve patient safety in hospitals. Consequently, many organizations have prioritized measuring VTE as an indicator of hospital quality; however, quality measures often assess VTE outcomes alone without considering practices to prevent VTE, including 1) risk assessment, 2) prophylaxis prescription, and 3) administration of prescribed VTE prophylaxis. Objectives: The purpose of this study is to evaluate completion of processes that contribute to effective VTE prevention among patients with hospital-acquired VTE and determine if VTE outcome-only approaches to measuring care quality are valid. Methods: We included all adult patients who developed in-hospital VTE at any of the five adult hospitals across the Johns Hopkins Health System, including two academic hospitals and three community hospitals, from January 1, 2024 – September 30, 2024. Our primary outcome was “defect free care”, a composite process-linked VTE outcome measure defined as the proportion of patients with hospital-acquired VTE who had 1) a VTE risk assessment completed, 2) prophylaxis prescribed, and 3) received all doses of prescribed VTE prophylaxis. Other outcomes included the proportion of prescribed VTE prophylaxis doses given, refused, and missed for reasons other than refusal among patients with hospital-acquired VTE. Results: A total of 311 patients with hospital-acquired VTE were included. The composite process-linked VTE outcome measure varied significantly between hospitals, with the proportion of patients having received “defect free care” from 17.4% to 46.1% (p=0.044, Figure 1). The hospital with the largest number of VTE also had the highest performance on the process-linked VTE outcome measure (Figure 1). Administration of prescribed pharmacologic VTE prophylaxis doses varied significantly between hospitals from 87.2% to 97.7% (p<0.001, Figure 2). Conclusions: VTE outcomes-only approaches for quality measurement fail to account for variation in prevention practice between hospitals. We have demonstrated that measuring this composite process-linked VTE outcome is feasible using only electronically available data and may better characterize prevention practice than outcomes alone. Any potential misclassification of preventable harm (by designating a VTE in patients who had received “defect free care” as low quality care), has the potential to inappropriately assess substantial financial penalties, and minimize the value of identifying opportunities to improve prevention practice. Quality measures should assess hospitals on modifiable gaps in care, and VTE measures should assess completion of all steps in the prevention pathway to achieve defect-free care.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.