Diagnostic Delay of Venous Thromboembolism in Primary Care
Compare Versions of: "Diagnostic Delay of Venous Thromboembolism in Primary Care"
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| Measure Information | 2026 Performance Period |
|---|---|
| Title | Diagnostic Delay of Venous Thromboembolism in Primary Care |
| CMS eCQM ID | CMS1173v1 |
| CBE ID* | 3749e |
| Measure Steward | Brigham and Womens Health |
| Description | Percentage of episodes for patients 18 years of age and older with documented Venous Thromboembolism (VTE) symptoms in the primary care setting and who had a diagnosis of VTE that occurs > 24 hours and within 30 days following the index primary care visit where symptoms for the VTE were... first present. Show more >Percentage of episodes for patients 18 years of age and older with documented Venous Thromboembolism (VTE) symptoms in the primary care setting and who had a diagnosis of VTE that occurs > 24 hours and within 30 days following the index primary care visit where symptoms for the VTE were first present. Show less |
| Measure Scoring | Proportion measure |
| Measure Type | Intermediate Outcome |
| Stratification |
None |
| Risk Adjustment |
None |
| Rationale | Venous Thromboembolism or VTE disease consists of pulmonary embolism and deep vein thrombosis. VTE is a deadly disease and more timely treatment can improve patient outcomes (Beckman, et al. 2010). Evidence from the literature as well as data from our site support this linkage. According... to the Centers for Disease Control and Prevention (CDC) up to 900,000 people in USA are affected by VTE which results is more than 100,000 deaths each year (CDC, 2024). Pulmonary embolism (PE) is an independent predictor of reduced survival for up to 3 months after onset and up to 45% of patients with a PE die within 3 months (Heit JA, 2006). VTE is also associated with increased morbidity, increased health care costs and decreased quality of life (Rathbun S, 2009 and Rabinovich N, 2017). Long term morbidity includes post-thrombotic syndrome (PTS) and pulmonary hypertension (Kahn SR, 2004). PTS is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients (Rabinovich N, 2017). PTS is associated with chronic venous insufficiency and associated signs and symptoms can impose significant morbidity and have a negative impact on quality of life. VTE can also have an impact on subsequent pregnancies, estrogen use, surgery, life insurance and travel (Tran HA, 2019). The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. The evidence that PE increases morbidity and mortality is robust and DVT is strongly associated with PE. Traditionally, there has not been a systematic way to measure the incidence of delayed diagnosis of VTE and therefore the estimates in the literature are based on manual record review and vary widely. The DOVE eCQM is an automated tool that quantifies delayed diagnosis that builds a foundation for automated VTE risk assessment and prompt treatment to prevent delayed diagnosis and adverse outcomes. The American Society of Hematology published VTE diagnosis guidelines to provide an evidence-based strategy to efficiently evaluate patients (Lim, 2018, updated 2022). The goal of these guidelines is to improve diagnostic accuracy by assisting providers with evaluating patients with suspected VTE while reducing unnecessary and more invasive testing (Lim, et al. 2018). While routine use of guidelines in primary care would likely reduce the number of missed or delayed VTE diagnoses, integration into practice is challenging. VTE symptoms are nonspecific and often present as symptoms consistent with an underlying chronic illness. Strategies such as clinical decision support and measurement of diagnostic performance are needed to assist primary care providers with adopting VTE diagnosis guidelines and routinely using them in clinical practice. Currently, there is no way to measure VTE diagnostic performance. Metrics are needed to quantify suboptimal VTE diagnostic performance, improved early recognition of VTE symptoms, and ultimately reducing unfavorable VTE outcomes. Measuring and reporting delayed VTE diagnosis rates will inform healthcare providers and facilities about opportunities to improve care, strengthen incentives for quality improvement, and ultimately improve the quality of care received by patients. Show more >Venous Thromboembolism or VTE disease consists of pulmonary embolism and deep vein thrombosis. VTE is a deadly disease and more timely treatment can improve patient outcomes (Beckman, et al. 2010). Evidence from the literature as well as data from our site support this linkage. According to the Centers for Disease Control and Prevention (CDC) up to 900,000 people in USA are affected by VTE which results is more than 100,000 deaths each year (CDC, 2024). Pulmonary embolism (PE) is an independent predictor of reduced survival for up to 3 months after onset and up to 45% of patients with a PE die within 3 months (Heit JA, 2006). VTE is also associated with increased morbidity, increased health care costs and decreased quality of life (Rathbun S, 2009 and Rabinovich N, 2017). Long term morbidity includes post-thrombotic syndrome (PTS) and pulmonary hypertension (Kahn SR, 2004). PTS is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients (Rabinovich N, 2017). PTS is associated with chronic venous insufficiency and associated signs and symptoms can impose significant morbidity and have a negative impact on quality of life. VTE can also have an impact on subsequent pregnancies, estrogen use, surgery, life insurance and travel (Tran HA, 2019). The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. The evidence that PE increases morbidity and mortality is robust and DVT is strongly associated with PE. Traditionally, there has not been a systematic way to measure the incidence of delayed diagnosis of VTE and therefore the estimates in the literature are based on manual record review and vary widely. The DOVE eCQM is an automated tool that quantifies delayed diagnosis that builds a foundation for automated VTE risk assessment and prompt treatment to prevent delayed diagnosis and adverse outcomes. The American Society of Hematology published VTE diagnosis guidelines to provide an evidence-based strategy to efficiently evaluate patients (Lim, 2018, updated 2022). The goal of these guidelines is to improve diagnostic accuracy by assisting providers with evaluating patients with suspected VTE while reducing unnecessary and more invasive testing (Lim, et al. 2018). While routine use of guidelines in primary care would likely reduce the number of missed or delayed VTE diagnoses, integration into practice is challenging. VTE symptoms are nonspecific and often present as symptoms consistent with an underlying chronic illness. Strategies such as clinical decision support and measurement of diagnostic performance are needed to assist primary care providers with adopting VTE diagnosis guidelines and routinely using them in clinical practice. Currently, there is no way to measure VTE diagnostic performance. Metrics are needed to quantify suboptimal VTE diagnostic performance, improved early recognition of VTE symptoms, and ultimately reducing unfavorable VTE outcomes. Measuring and reporting delayed VTE diagnosis rates will inform healthcare providers and facilities about opportunities to improve care, strengthen incentives for quality improvement, and ultimately improve the quality of care received by patients. Show less |
| Clinical Recommendation Statement | Venous Thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant and often fatal condition that affects up to 900,000 individuals in the U.S. each year, resulting in over 100,000 deaths (CDC, 2024). Evidence indicates that prompt diagnosis... and timely initiation of treatment can significantly reduce mortality and improve patient outcomes, particularly in primary care where VTE symptoms are frequently under-recognized (Beckman et al., 2010). Show more >Venous Thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant and often fatal condition that affects up to 900,000 individuals in the U.S. each year, resulting in over 100,000 deaths (CDC, 2024). Evidence indicates that prompt diagnosis and timely initiation of treatment can significantly reduce mortality and improve patient outcomes, particularly in primary care where VTE symptoms are frequently under-recognized (Beckman et al., 2010). Show less |
| Improvement Notation |
A lower score (expressed as a percentage) is indicative of higher quality care. |
| Definition | A Qualified VTE Encounter is an encounter performed by a qualified provider types with VTE diagnosis code (ICD10). a VTE-related imaging scan is performed during the encounter within 30 days of the index PCP visit where patient reports VTE symptoms and an anticoagulant medication ordered... within 12 hours (before or after) the imaging scan result. Show more >A Qualified VTE Encounter is an encounter performed by a qualified provider types with VTE diagnosis code (ICD10). a VTE-related imaging scan is performed during the encounter within 30 days of the index PCP visit where patient reports VTE symptoms and an anticoagulant medication ordered within 12 hours (before or after) the imaging scan result. Show less |
| Guidance | This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older at the start of the Qualified VTE Encounter during the measurement period. This measure is to be reported for every eligible encounter during the measurement... period. This eCQM is intended to be reported by integrated health systems with access to both ambulatory and inpatient documentation. The VTE symptoms can be captured through structured, coded data (see “VTE Symptoms” value set). Reporters of the eCQM can also opt to use clinical notes and a Natural Language Processing (NLP) platform that can be freely licensed from Brigham and Women’s Hospital (BWH). This platform, VTExt, is part of the MTERMS platform of Python NLP tools (proprietary to the BWH MTERMS lab). For access to the full MTERMS VTExt tool, please contact the MTERMS lab at BWHMTERMS@bwh.harvard.edu. When using NLP, the MTERMS VTExt tool is not required; however, the expectation for the eCQM is to use the same rule-based approach implemented by BWH. Reporters of the eCQM can use their own code to better suit their organization’s database / note structure / formatting, but such code should use the same rule-based NLP approach as VTExt (i.e., regular expressions). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more >This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older at the start of the Qualified VTE Encounter during the measurement period. This measure is to be reported for every eligible encounter during the measurement period. This eCQM is intended to be reported by integrated health systems with access to both ambulatory and inpatient documentation. The VTE symptoms can be captured through structured, coded data (see “VTE Symptoms” value set). Reporters of the eCQM can also opt to use clinical notes and a Natural Language Processing (NLP) platform that can be freely licensed from Brigham and Women’s Hospital (BWH). This platform, VTExt, is part of the MTERMS platform of Python NLP tools (proprietary to the BWH MTERMS lab). For access to the full MTERMS VTExt tool, please contact the MTERMS lab at BWHMTERMS@bwh.harvard.edu. When using NLP, the MTERMS VTExt tool is not required; however, the expectation for the eCQM is to use the same rule-based approach implemented by BWH. Reporters of the eCQM can use their own code to better suit their organization’s database / note structure / formatting, but such code should use the same rule-based NLP approach as VTExt (i.e., regular expressions). This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less |
| Initial Population |
All Qualified VTE Encounters in which the patient was aged 18 or older at the start of the Qualified VTE Encounter. |
| Denominator |
Equals Initial Population. |
| Denominator Exclusions | Exclude qualified VTE encounter with a hospice care service documented within previous 90 Days Exclude qualified VTE encounter with a palliative care service documented within previous 90 DaysExclude qualified VTE encounter with another qualified VTE encounter documented within previous 6...months Show more >Exclude qualified VTE encounter with a hospice care service documented within previous 90 Days Exclude qualified VTE encounter with a palliative care service documented within previous 90 Days Exclude qualified VTE encounter with another qualified VTE encounter documented within previous 6 months Show less |
| Numerator |
All qualified VTE encounters in which the VTE diagnosis occurs greater than 24 hours and within 30 days following the index PCP visit. |
| Numerator Exclusions |
None |
| Denominator Exceptions |
None |
| Telehealth Eligible | Yes |
| Next Version | No Version Available |
| Previous Version | No Version Available |
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