The ACCP Provides Comment to The Joint Commission on Venous Thromboembolism Measures
October 7, 2011
On behalf of the American College of Chest Physicians (ACCP), the ACCP Quality Improvement Committee (QIC) appreciates the opportunity to submit comments on this measure set. The QIC has reviewed the venous thromboembolism (VTE) measures a number of times and has submitted their comments to the National Quality Forum. Those comments have been included below.
NQF 0371/VTE-1: VTE Prophylaxis Within 24 Hours of Arrival
Approve with comments. On behalf of the American College of Chest Physicians (ACCP), the ACCP Quality Improvement Committee (QIC) appreciates the opportunity to comment on this measure. The ACCP approves this measure but recommends that those who have already received anticoagulation therapy or those with contraindications be excluded.
NQF 0372/VTE-2: ICU VTE Prophylaxis
Disapprove with comments. On behalf of the American College of Chest Physicians (ACCP), the ACCP Quality Improvement Committee (QIC) appreciates the desire to capture information on different patient populations from those captured in VTE-1. That said, because VTE-1 and VTE-2 are intended for implementation in electronic health records, it would be possible to segment out the ICU population from VTE-1. This would make it possible to understand compliance rates in the hospital population vs. the ICU setting.
NQF 0373/VTE-3: Anticoagulation Overlap Therapy
Disapprove with comments. The ACCP appreciates the science used to develop this measure. However, the feasibility related to the excess burden of collecting required data makes this measure a low priority. This measure is also contrary to the recommendations in Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 8th Edition.
NQF 0374/ VTE-4: Platelet Monitoring on Unfractionated Heparin
Disapprove with comments. On behalf of the American College of Chest Physicians (ACCP), the ACCP Quality Improvement Committee (QIC) appreciates the opportunity to comment on this measure. While the QIC agrees with the concept of platelet monitoring, it does not agree that this measure should be adopted into electronic health records because it is a rare condition and will not capture quality of care. To actually improve care, it would be useful to capture what is done once a platelet count drops.
NQF 0375/ VTE-5: VTE Discharge Instructions
Approve with comments. On behalf of the American College of Chest Physicians (ACCP), the ACCP Quality Improvement Committee (QIC) appreciates the opportunity to comment on this measure. The QIC approves of this measure because it feels that patient education is essential to patient care. The QIC is concerned that this measure has the potential to be gamed because it does not measure patient comprehension of discharge instructions. The QIC recommends measuring whether the patient receiving anticoagulation therapy is being monitored or followed by an anticoagulation specialist. We need ways to measure if we are assessing patients appropriately.
NQF 0376/VTE-6: Incidence of Potentially Preventable VTE
Approve as written. On behalf of the American College of Chest Physicians (ACCP), the ACCP Quality Improvement Committee (QIC) appreciates the opportunity to comment on this measure.
Considering the previous comments by the QIC, the QIC recommends that The Joint Commission keep VTE-1 and VTE-6 in the measure set and remove VTE-2, VTE-3, VTE-4, and VTE-5 from the measure set.
