ICD-9 Code-Based Venous Thromboembolism Performance Targets Fail to Measure Up.

Authors:
Brandyn D Lau
Brandyn D Lau
Johns Hopkins University School of Medicine
United States
Elliott R Haut
Elliott R Haut
Johns Hopkins University School of Medicine
United States
Deborah B Hobson
Deborah B Hobson
The Johns Hopkins University School of Medicine
United States
Peggy S Kraus
Peggy S Kraus
The Johns Hopkins Hospital
United States
Chepkorir Maritim
Chepkorir Maritim
The Armstrong Institute for Patient Safety
Kenneth M Shermock
Kenneth M Shermock
The Johns Hopkins Hospital
United States
Bhunesh Maheshwari
Bhunesh Maheshwari
Johns Hopkins University School of Medicine
Baltimore | United States

Am J Med Qual 2016 09 21;31(5):448-53. Epub 2015 Apr 21.

The Johns Hopkins University School of Medicine, Baltimore, MD The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD.

Venous thromboembolism (VTE) is a common complication among hospitalized patients. Suboptimal prevention practices have prompted payers to consider hospital-associated VTE as a potentially preventable condition for which financial incentives or penalties exist to drive practice improvement. The authors reviewed all cases of hospital-associated VTE at the Johns Hopkins Hospital between July 1, 2010, and June 30, 2011, that were identified by ICD-9 codes used by a state-run pay-for-performance quality improvement program. Of 157 patients identified as having developed hospital-associated, potentially preventable VTE, only 92 (58.6%) patients developed radiographically confirmed VTE that were potentially preventable. This misclassification of VTE overestimates the marginal additional treatment cost by more than $860 000 and amounts to nearly $200 000 in lost reward in one year alone. ICD-9 codes alone have extremely low positive predictive value to identify true VTE events. The authors recommend linking provision of risk-appropriate prophylaxis to VTE outcomes as a better target for performance improvement.

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http://dx.doi.org/10.1177/1062860615583547DOI Listing
September 2016
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