Venous Thromboembolism Discharge Instructions

Last updated: May 17, 2016

CMS Measure ID: CMS110v4
Version: 4
NQF Number: None
Measure Description:

This measure assesses the number of patients diagnosed with confirmed VTE that are discharged to home, home care, court/law enforcement or home on hospice care on warfarin with written discharge instructions that address all four criteria: compliance issues, dietary advice, follow-up monitoring, and information about the potential for adverse drug reactions/interactions.

Initial Patient Population:

Patients age 18 and older discharged from hospital inpatient acute care during the measurement period with a length of stay less than or equal to 120 days and a diagnosis of venous thromboembolism (VTE)

Denominator Statement:

Patients with VTE confirmed through a diagnostic test and discharged to home or court/law enforcement on warfarin therapy.

Denominator Exclusions:

None

Numerator Statement:

Patients with documentation that they or their caregivers were given written discharge instructions or other educational material about warfarin that addressed all of the following:

  1. compliance issues
  2. dietary advice
  3. follow-up monitoring
  4. potential for adverse drug reactions and interactions

Patients who refuse written discharge instructions or other educational material about warfarin.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: The Joint Commission
Domain: Person and Caregiver-Centered Experience Outcomes
Short Name: VTE5
Next Version: Venous Thromboembolism Discharge Instructions
Previous Version: Venous Thromboembolism Discharge Instructions
Measure Score: Proportion
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

CMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure.

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.

Written information given to the patient is required to address each and every one of the educational components. These components are modeled in the population criteria and data criteria as communication from provider to patient: adverse reactions and interactions, INR monitoring and medication compliance, dietary advice and follow-up monitoring, and are intended to be specific to discharge instructions for warfarin therapy. The educational components are intended as discharge instructions and not as verbal education.

Specifications

Release Notes

Header

  • Added guidance statement from CMS regarding the capture of the VTE confirmed concept and its impact on the use of the measure.
  • Copyright updated.
  • eMeasure version number incremented.
  • Updated references in header.
  • Updated the Numerator header statement to include patient refusal to better align with measure logic.

Logic

  • Added timing relationship for each indivdual 'AND' statement in the Numerator logic to clarify the applicability of the timing relationship.
  • Changed data type of 'Result' or 'Finding' to 'Performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the 'Intersection of' operator to specify the selection of the data sets common to all individual statements underneath the 'Intersection of'.
  • Introduced variables $EncounterInpatient and $DiagnosisVTE to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed occurrencing and added timing constraint to 'Encounter, Performed: Emergency Department Visit' when this QDM element is used on the right-hand side of a temporal operation, to enforce a constraint that wasn't necessarily achieved through occurrencing alone.
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced timing relationship 'during' with 'starts during' where both a start datetime and an end datetime associated with a particular QDM element are not critical to fulfill the measure intent.
  • Replaced timing relationship 'ends before start of' with 'ends before or concurrent with start of' in logic criteria relating 'Encounter, Performed: Emergency Department Visit' and $EncounterInpatient, allowing for the Emergency Department Visit discharge to occur in the same minute as the inpatient admission.

Value Sets

  • Value set Obstetrics VTE (OID 2.16.840.1.113883.3.117.1.7.1.264): Added 8 ICD10CM codes (O03.35, O07.35, O22.8X1, O22.8X2, O22.8X3, O22.8X9, O87.0, O87.3) and 1 SNOMED code (609497003).
  • Value set Venous Thromboembolism (OID 2.16.840.1.113883.3.117.1.7.1.279): Deleted 5 ICD10CM codes (I80.231, I80.232, I80.233, I80.239, I82.210) and 12 SNOMED codes. Added 4 SNOMED codes (1001000119102, 132251000119101, 132251000119106, 132251000119107).
  • Value set VTE Confirmed (OID 2.16.840.1.113883.3.117.1.7.1.407): Deleted 37 SNOMED codes; added 5 SNOMED codes (1001000119102, 132251000119101, 132251000119106, 132301000119107, 57834008).

External Resources