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## Complete Summary

#### TITLE

Venous thromboembolism (VTE) prophylaxis: percentage of adult
hospitalized patients who are assessed to be at risk for VTE who receive
pharmacologic prophylaxis, unless contraindicated.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Venous
thromboembolism prophylaxis. Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2007 Jun. 52 p. \[99 references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of adult hospitalized
patients who are assessed to be at risk for venous thromboembolism (VTE)
who receive pharmacologic prophylaxis, unless contraindicated.

#### RATIONALE

The priority aim addressed by this measure is to increase the percentage
of hospitalized adult patients (18 years and older) receiving
appropriate prophylaxis treatment within 24 hours of admission.

#### PRIMARY CLINICAL COMPONENT

Venous thromboembolism (VTE); pharmacologic prophylaxis

#### DENOMINATOR DESCRIPTION

Total number of adult hospitalized patients at risk for venous
thromboembolism (VTE) (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Total number of adult hospitalized patients at risk for venous
thromboembolism (VTE) who receive pharmacologic prophylaxis, unless
contraindicated (see the related \"Numerator Inclusions/Exclusions\"
field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Venous thromboembolism
    prophylaxis.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=11286)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Venous thromboembolism (VTE) is highly prevalent in hospitalized
patients undergoing procedures or suffering significant trauma.
Surveillance data collected from several studies show that the incidence
of VTE by phlebography or fibrinogen scan uptake can be as high as 45 to
50% in elective hip replacement, knee replacement, hip fracture and
patients with multiple trauma. Venographic data suggest an incidence of
25 to 35% in patients undergoing general, urologic and gynecologic
surgery.

Though the incidence of clinically significant disease is less than
venographic findings, patients can have as high as a 1.6%, 4%, or 6.9%
risk of clinical pulmonary embolism with general surgery, elective hip
replacement or traumatic orthopedic surgery respectively.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Institute for Clinical Systems Improvement (ICSI). Venous
thromboembolism prophylaxis. Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2007 Jun. 52 p. \[99 references\]

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Adults 18 and older admitted to the hospital for a medical condition or
surgery who are at risk for venous thromboembolism (VTE)

From discharge records, a list of all adult hospitalized patients will
need to be reviewed for VTE criteria during the target period. The
medical records can be reviewed to determine if anticoagulation
prophylaxis was administered.

Data may be collected monthly.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of adult hospitalized patients at risk for venous
thromboembolism (VTE)\*

\*Patients are at risk for VTE if:

-   Admission to the intensive care unit (ICU),

-   Estimated length of stay is four days or more or extended immobility
    exists,

-   75 years of age or more,

-   Thrombophilia - acquired or congenital,

-   Active cancer or myeloproliferative disorders,

-   Uncompensated heart failure,

-   Acute infection,

-   Inflammatory bowel disease,

-   Nephrotic syndrome,

-   Rheumatoid/Collagen vascular disorders, or

-   Obesity (body mass index \[BMI\] greater than or equal to 30)

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Institutionalization

#### DENOMINATOR TIME WINDOW

Time window brackets index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of adult hospitalized patients at risk for venous
thromboembolism (VTE) who receive pharmacologic prophylaxis, unless
contraindicated (see exclusions below)

**Exclusions**\
Contraindications include but are not limited to:

-   Thrombocytopenia (platelet count less than 50,000 mm~3~),

-   History of heparin-induced thrombocytopenia (for low molecular
    weight heparin \[LMWH\] and unfractionated heparin \[UFH\]),

-   Active hepatitis or hepatic insufficiency, or

-   Other conditions that could increase risk of bleeding

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of adult hospitalized patients who are assessed to be at risk
for VTE who receive pharmacologic prophylaxis, unless contraindicated.

#### MEASURE COLLECTION

[Venous Thromboembolism Prophylaxis
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=26&doc=9588)

#### DEVELOPER

Institute for Clinical Systems Improvement

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2006 Jun

#### REVISION DATE

2007 Jun

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems
Improvement (ICSI). Venous Thromboembolism Prophylaxis. Bloomington
(MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jun. 51 p.

#### SOURCE(S)

Institute for Clinical Systems Improvement (ICSI). Venous
thromboembolism prophylaxis. Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2007 Jun. 52 p. \[99 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of adult hospitalized patients who
are assessed to be at risk for VTE who receive pharmacologic
prophylaxis, unless contraindicated,\" is published in \"Health Care
Guideline: Venous Thromboembolism Prophylaxis.\" This document is
available from the [Institute for Clinical Systems Improvement (ICSI)
Web
site](http://www.icsi.org/guidelines_and_more/guidelines__order_sets___protocols/).

For more information, contact ICSI at, 8009 34th Avenue South, Suite
1200, Bloomington, MN 55425; phone: 952-814-7060; fax: 952-858-9675; Web
site: [www.icsi.org](http://www.icsi.org/); e-mail:
<icsi.info@icsi.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI on October 17, 2006. This NQMC
summary was updated by ECRI Institute on October 1, 2007.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008