Back to top
Top
U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Intensive Care Unit Venous Thromboembolism Prophylaxis

Compare Versions of: "Intensive Care Unit Venous Thromboembolism Prophylaxis"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Compare version to

Measure Information 2022 Reporting Period 2023 Reporting Period 2024 Reporting Period
Title Intensive Care Unit Venous Thromboembolism Prophylaxis Intensive Care Unit Venous Thromboembolism Prophylaxis Intensive Care Unit Venous Thromboembolism Prophylaxis
CMS eCQM ID CMS190v10 CMS190v11 CMS190v12
Short Name

VTE-2

VTE-2

VTE-2

CBE ID Not Applicable Not Applicable Not Applicable
Description

This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

This measure assesses the number of patients who received Venous Thromboembolism (VTE) prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

This measure assesses the number of patients who received Venous Thromboembolism (VTE) prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

Definition *See CMS190v10.html *See CMS190v11.html

None

Initial Population

Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

Inpatient hospitalizations for patients age 18 and older, discharged from hospital inpatient acute care without a diagnosis of venous thromboembolism (VTE) or obstetrics with a length of stay less than or equal to 120 days that ends during the measurement period

Numerator

Inpatient hospitalizations for patients who received VTE prophylaxis:

- the day of or the day after ICU admission (or transfer)

- the day of or the day after surgery end date for surgeries that end the day of or the day after ICU admission (or transfer)

Inpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:

- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission (or transfer)

Inpatient hospitalizations for patients who received VTE prophylaxis:

- the day of or the day after ICU admission (or transfer)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:

- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who received VTE prophylaxis:

- the day of or the day after ICU admission (or transfer)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Inpatient hospitalizations for patients who have documentation of a reason why no VTE prophylaxis was given:

- between the day of arrival and the day after ICU admission (for patients directly admitted as inpatients to the ICU)

- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission or transfer)

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator

Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization

Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization

Inpatient hospitalizations for patients directly admitted or transferred to ICU during the hospitalization

Denominator Exclusions

* Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days

* Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer

* Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after hospital admission

* Inpatient hospitalizations for patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

* Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days

* Inpatient hospitalizations for patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

* Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer

* Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after hospital admission

- Inpatient hospitalizations for patients who have a hospital length of stay (LOS) less than 2 days

- Inpatient hospitalizations for patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer

- Inpatient hospitalizations for patients with comfort measures documented anytime between the day of arrival and the day after ICU admission or transfer

- Inpatient hospitalizations for patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after ICU admission or transfer

Denominator Exceptions

Inpatient hospitalizations for patients with ICU LOS less than one day

Inpatient hospitalizations for patients with ICU LOS less than one day

Inpatient hospitalizations for patients with ICU LOS less than one day

Measure Steward The Joint Commission The Joint Commission The Joint Commission
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Guidance

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project (2022). An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas.

Reasons for no pharmacological and no mechanical VTE prophylaxis must be explicitly documented by the MD/APN/PA or pharmacist and linked with VTE prophylaxis. Ambulation alone is not a sufficient reason for not administering VTE prophylaxis. In order for ambulation/patient ambulating to be considered as an acceptable reason, there needs to be explicit documentation, e.g., "patient out of bed and ambulating in halls - no VTE prophylaxis needed."

The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Rationale *See CMS190v10.html *See CMS190v11.html

Venous Thromboembolism (VTE) is a known complication of hospitalization, frequently extending the length of stay and increasing hospital mortality (Maynard, 2016). Approximately 20% of VTE are associated with a surgical procedure (Henke et al., 2020).

Almost all hospitalized patients have at least one risk factor for VTE, and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired deep-vein thrombosis (DVT) is approximately 10% to 40% among medical or general surgical patients and 40% to 60% following major orthopedic surgery (Geerts et al., 2008).

Commonly, criteria for admission to the Intensive Care Unit (ICU) itself puts patients at an increased risk for developing VTE and subsequent increased risk of morbidity from pulmonary embolism (PE). Some risk factors are related to the acute illness present that allowed for the admission to the ICU unit, and some risk factors may be acquired during the ICU admission due to subsequent medical treatments, for example limitations of mobility, presence of central venous lines or mechanical ventilation and subsequent pharmacological paralysis. Reports of DVT in the population of ICU patients vary in relation to the acuity of the illness in this population. DVT in ICU patients diagnosed with routine venography or Doppler ultrasound found ranges between 10% to 100%. Five studies prospectively screened patients who were not receiving thromboprophylaxis during their ICU stays. The rates of DVT using Fibrinogen Uptake Test, Doppler Ultrasound or venography ranged from 13 to 31% (Geerts et al., 2008). It is essential for all ICUs to assess each patient upon admission to the ICU unit, a change in level of status, for the need for VTE prophylaxis due to the above increased development of risk factors (Geerts et al., 2004).

American Society of Hematology (ASH) 2018 VTE prophylaxis guidelines strongly recommend pharmacological prophylaxis using unfractionated heparin (UFH), low molecular weight heparin (LMWH) or fondaparinux for acutely and critically ill hospitalized medical patients, unless contraindicated. The use of mechanical prophylaxis is an acceptable alternative for patients with increased risk of bleeding and preferred over no prophylaxis. ASH 2019 guidelines for surgical patients similarly recommend pharmacological or mechanical prophylaxis over no VTE prophylaxis.

Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.

Stratification *See CMS190v10.html *See CMS190v11.html

None

Risk Adjustment *See CMS190v10.html *See CMS190v11.html

None

Clinical Recommendation Statement *See CMS190v10.html *See CMS190v11.html

Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for critically ill hospitalized patients for developing a deep vein thrombosis or dying from a pulmonary embolism. Screening all patients is the only evidence based practice in reducing incidence of disease. All intensive care unit (ICU) patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.

Next Version No Version Available
Previous Version No Version Available

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Corrected a misspelling.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Added clarifying language to the guidance section of episode-based measures to define the episode.

    Measure Section: Guidance

    Source of Change: Measure Lead

Logic

  • Created a library named 'VTE' for an Initial Population definition that is shared by both VTE-1 and VTE-2 measures.

    Measure Section: Initial Population

    Source of Change: Annual Update

  • Updated Global.'Inpatient Encounter' definition by adding 'day of' to ensure all cases within the measurement period are captured and evaluated in the initial population.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Replace relevantDatetime with Global.'EarliestOf'() for assessment performed datatype to decrease implementation burden due to variable use of timing attributes for the same QDM datatypes used across measures.

    Measure Section: Multiple Sections

    Source of Change: ONC Project Tracking System (Jira): CQM-3873

  • Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated VTEICU CQL Library to version 5.2.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated TJC_Overall CQL Library to version 5.2.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment (2.16.840.1.113883.3.117.1.7.1.134): Deleted 2 RxNorm codes (1927856, 1927864) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Low Molecular Weight Heparin for VTE Prophylaxis (2.16.840.1.113883.3.117.1.7.1.219): Deleted 1 RxNorm code (978713) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set General Surgery (2.16.840.1.113883.3.117.1.7.1.255): Deleted 7 SNOMED CT codes (173743009, 173744003, 174309007, 235280006, 239989009, 287794009, 287861004) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Obstetrics VTE (2.16.840.1.113883.3.117.1.7.1.264): Deleted 2 SNOMED CT codes (200302000, 663008) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Venous Thromboembolism (2.16.840.1.113883.3.117.1.7.1.279): Deleted 1 ICD-10-CM code (I28.9) based on review by technical experts, SMEs, and/or public feedback. Deleted 2 SNOMED CT codes (276494008, 413956008) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Obstetrics (2.16.840.1.113883.3.117.1.7.1.263): Added 3 ICD-10-CM codes (O99.891, O99.892, O99.893) based on terminology update. Deleted 36 SNOMED CT codes and 1 ICD-10-CM code (O99.89) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Renamed value set Rivaroxaban for VTE Prophylaxis (2.16.840.1.113762.1.4.1110.50) based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Rivaroxaban for VTE Prophylaxis (2.16.840.1.113762.1.4.1110.50): Deleted 2 RxNorm codes (1927856, 1927864) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

Last Updated: Mar 04, 2024