Venous Thromboembolism Patients with Anticoagulation Overlap Therapy

Last updated: May 4, 2017

CMS Measure ID: CMS73v3
Version: 3
NQF Number: 0373
Measure Description:

This measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they should be discharged on both medications or have a reason for discontinuation of overlap therapy. Overlap therapy should be administered for at least five days with an international normalized ratio (INR) greater than or equal to 2 prior to discontinuation of the parenteral anticoagulation therapy, discharged on both medications or have a reason for discontinuation of overlap therapy.

Initial Patient Population:

Patients with a diagnosis code for venous thromboembolism (VTE), a patient age greater than or equal to 18 years, and a length of stay less than or equal to 120 days.

Denominator Statement:

Patients with confirmed VTE who received warfarin.

Denominator Exclusions:
  • Patients with Comfort Measures documented
  • Patients discharged to a health care facility for hospice care
  • Patients discharged to home for hospice care
  • Patients who expired
  • Patients who left against medical advice
  • Patients discharged to another hospital
  • Patients without warfarin therapy during hospitalization
  • Patients without VTE confirmed by diagnostic testing
Numerator Statement:

Patients who received overlap therapy (warfarin and parenteral anticoagulation):

  • Five or more days, with an INR greater than or equal to 2 prior to discontinuation of parenteral therapy OR
  • Five or more days, with an INR less than 2 and discharged on overlap therapy OR
  • Less than five days and discharged on overlap therapy OR
  • With documentation of reason for discontinuation of parenteral therapy OR
  • With documentation of a reason for no overlap therapy
Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: The Joint Commission
Domain: Effective Clinical Care
Short Name: VTE3
Next Version: Venous Thromboembolism Patients with Anticoagulation Overlap Therapy
Measure Score: Proportion
Score Type: Process
Improvement Notation:

An increase in the rate

Guidance:

The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

For date difference calculations, use the LAST (most recent) of the alternative dates as the end date and the EARLIEST of the alternative dates as the start date. The calculation should be performed as end date minus start date.

Specifications

External Resources