VTE rates don't reflect care quality

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The Centers for Medicare & Medicaid Services has long used venous thromboembolism (VTE) rates to determine hospital care quality, but a report finds this measure may not indicate care quality, according to Anesthesiology News.

Rather than reflecting quality, a provider's VTE rates indicates the frequency with which it conducts imaging tests--in short, hospitals that look harder for VTE are more likely to find it, according to research presented at the 2014 annual meeting of the American Surgical Association.

This means that CMS may penalize hospitals that are most vigilant about VTE for poor performance, author Mila H. Ju. M.D., of the American College of Surgeons (ACS) and Northwestern University in Chicago, said. Ju and her team analyzed 2009-2010 ACS National Surgical Quality Improvement Program data from 208 hospitals on patients undergoing 11 major procedures associated with increased VTE.

Their findings were consistent with earlier research that found a correlation between a hospital's VTE rates and frequency of imaging studies.

The results raise broader questions about the appropriateness of hospital quality measures, Samuel R.G. Finlayson, M.D., chair of surgery at the University of Utah in Salt Lake City, told Anesthesiology News. "The problems that the authors have uncovered related to VTE rates strengthen the argument of those who believe that outcome-based, pay-for-performance programs are not ready for prime time," he said.

VTEs are also not commonplace enough to be an effective measure of quality, said Hiram C. Polk, M.D., a professor of surgery at the University of Louisville in Kentucky, citing research from his department indicating deep vein thrombosis and pulmonary embolism rates after major elective procedures may be as low as 1 percent.

A recent report said critical care nurses must take precautions to reduce risks of death or complications from VTE, rather than simply "recognizing that deep vein thrombosis is a problem," FierceHealthcare previously reported.

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