eMeasure Title Venous Thromboembolism Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or Nomogram
eMeasure Identifier
(Measure Authoring Tool)
109 eMeasure Version number 1
NQF Number 0374 GUID bcce43dd-08e3-46c3-bfdd-0b1b472690f0
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Joint Commission
Measure Developer Joint Commission
Endorsed By National Quality Forum
Description
This measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using defined parameters such as a nomogram or protocol.
Copyright
Measure specifications are in the Public Domain.

LOINC(R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms(R) (SNOMED CT(c)) copyright 2004-–2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
None
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Unfractionated heparin (UFH) management by weight-based/activated partial thromboplastin time (aPTT) adjusted protocols have demonstrated their ability through clinical trials to achieve a therapeutic aPTT more rapidly than with standard UFH dosing without increasing major bleeding. UFH management by nomogram/protocol has significantly advanced the use of UFH with the demonstrated ability to achieve therapeutic PTTs more rapidly than with standard UFH dosing.

Heparin-induced thrombocytopenia (HIT) occurs more commonly in patients who receive UFH than in those who receive low molecular weight heparin. HIT is defined as an unexplained fall in platelet count (specifically, a 50% fall in platelet count from baseline, even if the platelet count remains above 150 x 109/L). Platelet counts generally begin to fall 5-10 days after the initiation of heparin therapy. Prompt recognition of HIT is important so that heparin can be discontinued and the risk of venous and arterial thrombosis minimized. To detect HIT, platelet count monitoring is recommended for all patients treated with UFH.
Clinical Recommendation Statement
NoneHeparin-induced thrombocytopenia (HIT) may occur in patients who receive unfractionated heparin (UHF) for treatment of thromboembolism. Prompt recognition of HIT by evaluation of platelet counts can allow for detection of HIT, and the subsequent discontinuation of UFH.  Management of UFH by nomogram/protocol is recommended to decrease the time outside of the therapeutic range.
Improvement Notation
An increase in rate
Reference
Cruickshank MK, Levine MN, Hirsh J et al. A standard heparin nomogram for the management of heparin therapy. Arch Intern Med. 1991 Feb;151(2):333-7.
Reference
Raschke RA, Reilly BM, Guidry JR et al. The weight-based heparin dosing nomogram compared with ‘standard care’ nomogram. Ann Intern Med. 1993 Nov 1;119(9):874-81.
Reference
Gunnarsson PD, Sawyer WT, Montague D et al. Appropriate use of heparin: Empiric vs. nomogram-based dosing. Arch Intern Med. 1995 Mar 13;155(5):526- 32.
Reference
Hirsch J, Bauer KA, Donati MB, Gould M, Samama MM, Weitz JI. Parenteral Anticoagulants: The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:141S-198S.
Definition
None
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.

The facility location arrival datetime and facility location departure datetime are coupled with the emergency department visit value set. They intend to represent arrival date/time at the emergency department and the discharge date/time from the emergency department, respectively.

Treatment adjustment by protocol and/or use of a clinical pathway must be specific to unfractionated heparin therapy. Heparin protocols and clinical pathways may include use of a nomogram.
Transmission Format
None
Initial Patient Population
Patients with a diagnosis of 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
Patients with confirmed VTE receiving IV UFH therapy
Denominator Exclusions
Patients with comfort measures only documented
Patients discharged to another hospital
Patients who left against medical advice
Patients who expired
Patients discharged to home for hospice care
Patients discharged to a health care facility for hospice care
Numerator
Patients who have their IV UFH therapy dosages AND platelet counts monitored according to defined parameters such as a nomogram or protocol.
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
eMeasure Venous Thromboembolism (eVTE)