VTE QUALITY INITIATIVES
Quality Initiatives: Closing the Gap Between VTE Prevention Guidelines and Clinical Practice
The healthcare community recognizes the need for reducing venous thromboembolism (VTE) risk after total hip replacement (THR) or total knee replacement (TKR) surgeries. Multiple modalities exist and evidence-based guidelines have been developed to provide direction regarding VTE prophylaxis in patients undergoing THR or TKR. Yet, even with effective prophylaxis and guidelines, VTE continues to impose a major burden on patients and the healthcare system.
In response, government and private sector organizations are implementing quality initiatives to help close the gap between guideline recommendations and real-world practice.
VTEs—including postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) following THR and TKR surgery—were designated as hospital-acquired conditions (HACs) by the Centers for Medicare & Medicaid Services (CMS) on July 31, 2008.1 HACs are conditions that are not present upon admission, but that are subsequently acquired during a hospital stay and could reasonably have been prevented through adherence to evidence-based guidelines.1 CMS will no longer pay for HACs and, by withholding payment, are encouraging hospitals to prevent an adverse event and improve the reliability of care.
Why Is VTE a Focus for Quality Initiatives?
VTE is associated with a significant burden to society:
- Between 200,000 and 300,000 US patients die of VTE each year (surgery-related and non–surgery-related)—more deaths than from AIDS, breast cancer, and traffic accidents combined2,3
- VTE causes an approximate 10% hospital readmission rate by day 90 postsurgery* and results in substantial resource utilization and excess charges4
According to the National Quality Forum, which developed the National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism with the Joint Commission:
- VTE is the most common preventable cause of hospital deaths in the United States5
- Patients with risk factors can be identified5
- Effective strategies are available to prevent DVT and PE5
Hip Replacement SurgeryFACT:
The Agency for Healthcare Research and Quality has reported that thromboprophylaxis was the number-one patient safety practice prioritized among nearly 70 practices reviewed3
Click on any of the links below to find out more about specific ways these organizations are attempting to help improve VTE prophylaxis strategies.
- National Quality Forum
- The Joint Commission
- Centers for Medicare & Medicaid Services
- Quality Improvement Organizations
- Accountable Care Organizations
- Office of the Surgeon General
*Results from a study using a large, integrated US healthcare claims database of patients undergoing THR, major knee surgery, or hip fracture repair (N=11,960) between January 1993 and December 1998. Patients were followed for 90 days postsurgery.4
References:
- Hospital-acquired conditions. Centers for Medicare & Medicaid Services Web site. http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp. Updated December 8, 2010. Accessed February 2, 2011.
- Heit JA, Cohen AT, Anderson FA Jr; on behalf of the VTE Impact Assessment Group. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. [ASH abstract 910]. Blood. 2005;106(11).
- Maynard G, Stein J. Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Rockville, MD: Agency for Healthcare Research and Quality: 2008. Publication 08-0075. http://www.ahrq.gov/QUAL/vtguide/vtguide.pdf. Accessed February 14, 2011.
- Oster G, Ollendorf DA, Vera-Llonch M, Hagiwara M, Berger A, Edelsberg J. Economic consequences of venous thromboembolism following major orthopedic surgery. Ann Pharmacother. 2004;38:377-382. doi:10.1345/aph.1C518.
- National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Additional Performance Measures. http://www.qualityforum.org/Publications/2008/10/National_Voluntary_Consensus_Standards_for_Prevention_and_Care_of_Venous_Thromboembolism__Additional_Performance_Measures.aspx. Published 2008. Accessed May 11, 2011.
