Venous Thromboembolism Prophylaxis

Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
- AND NOT:
  - OR: "Diagnosis, Active: Obstetrics"
  - OR: "Diagnosis, Active: Obstetrics VTE"
  - OR: "Diagnosis, Active: Venous Thromboembolism"
  - starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- AND:
  - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay < 2 day(s))"
  - OR: "Occurrence A of Encounter, Performed: ICU Admission or Transfer (length of stay >= 1 day(s))" <= 1 day(s) starts after start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR: "Diagnosis, Active: Mental Disorders (ordinality: 'Principal')" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Procedure, Performed: General Surgery (ordinality: 'Principal')"
    - OR: "Procedure, Performed: Gynecological Surgery (ordinality: 'Principal')"
    - OR: "Procedure, Performed: Hip Fracture Surgery (ordinality: 'Principal')"
    - OR: "Procedure, Performed: Hip Replacement Surgery (ordinality: 'Principal')"
    - OR: "Procedure, Performed: Intracranial Neurosurgery (ordinality: 'Principal')"
    - OR: "Procedure, Performed: Knee Replacement Surgery (ordinality: 'Principal')"
    - OR: "Procedure, Performed: Urological Surgery (ordinality: 'Principal')"
    - during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Diagnosis, Active: Hemorrhagic Stroke (ordinality: 'Principal')"
    - OR: "Diagnosis, Active: Ischemic Stroke (ordinality: 'Principal')"
    - starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" <= 1 hour(s) starts after end of "Occurrence A of Encounter, Performed: Emergency Department Visit"
    - AND:
      - OR: "Intervention, Order: Comfort Measures"
      - OR: "Intervention, Performed: Comfort Measures"
      - <= 1 day(s) starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
  - OR:
    - OR: "Intervention, Order: Comfort Measures"
    - OR: "Intervention, Performed: Comfort Measures"
    - <= 1 day(s) starts after start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Intervention, Order: Comfort Measures"
    - OR: "Intervention, Performed: Comfort Measures"
    - <= 1 day(s) starts after end of ("Procedure, Performed: General or Neuraxial Anesthesia" <= 1 day(s) ends after start of "Occurrence A of Encounter, Performed: Encounter Inpatient")
Numerator =
- AND:
  - OR:
    - OR: "Medication, Administered: Low Dose Unfractionated Heparin for VTE Prophylaxis (route: 'Subcutaneous route')"
    - OR: "Medication, Administered: Low Molecular Weight Heparin for VTE Prophylaxis"
    - OR: "Medication, Administered: Injectable Factor Xa Inhibitor for VTE Prophylaxis"
    - OR: "Medication, Administered: Warfarin"
    - OR: "Device, Applied: Intermittent pneumatic compression devices (IPC)"
    - OR: "Device, Applied: Venous foot pumps (VFP)"
    - OR: "Device, Applied: Graduated compression stockings (GCS)"
    - OR:
      - AND:
        
        OR: "Medication, Administered not done: Medical Reason" for "Low Dose Unfractionated Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Low Molecular Weight Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Injectable Factor Xa Inhibitor for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Warfarin "
        
        OR: "Medication, Order not done: Medical Reason" for "Unfractionated Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Warfarin-only ingredient specific "
      - AND:
        
        OR: "Device, Applied not done: Medical Reason" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Applied not done: Medical Reason" for "Venous foot pumps (VFP) "
        
        OR: "Device, Applied not done: Medical Reason" for "Graduated compression stockings (GCS) "
        
        OR: "Device, Order not done: Medical Reason" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Order not done: Medical Reason" for "Venous foot pumps (VFP) "
        
        OR: "Device, Order not done: Medical Reason" for "Graduated compression stockings (GCS) "
    - OR:
      - OR: "Medication, Administered: Unfractionated Heparin (route: 'Intravenous route')"
      - OR: "Laboratory Test, Result: INR (result > 3 )"
      - OR: "Risk Category Assessment: VTE Risk Assessment (result: 'Low Risk')"
      - OR: "Medication, Administered: Direct Thrombin Inhibitor"
      - OR: "Medication, Administered: Glycoprotein IIb/IIIa Inhibitors"
    - OR:
      - OR: "Medication, Administered not done: Patient Refusal" for "Low Dose Unfractionated Heparin for VTE Prophylaxis "
      - OR: "Medication, Administered not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE Prophylaxis "
      - OR: "Medication, Administered not done: Patient Refusal" for "Injectable Factor Xa Inhibitor for VTE Prophylaxis "
      - OR: "Medication, Administered not done: Patient Refusal" for "Warfarin "
      - OR: "Device, Applied not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC) "
      - OR: "Device, Applied not done: Patient Refusal" for "Venous foot pumps (VFP) "
      - OR: "Device, Applied not done: Patient Refusal" for "Graduated compression stockings (GCS) "
    - OR:
      - OR: "Medication, Order not done: Patient Refusal" for "Unfractionated Heparin for VTE prophylaxis ingredient specific "
      - OR: "Medication, Order not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific "
      - OR: "Medication, Order not done: Patient Refusal" for "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific "
      - OR: "Medication, Order not done: Patient Refusal" for "Warfarin-only ingredient specific "
      - OR: "Device, Order not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC) "
      - OR: "Device, Order not done: Patient Refusal" for "Venous foot pumps (VFP) "
      - OR: "Device, Order not done: Patient Refusal" for "Graduated compression stockings (GCS) "
    - <= 1 day(s) starts after start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Medication, Administered: Low Dose Unfractionated Heparin for VTE Prophylaxis (route: 'Subcutaneous route')"
    - OR: "Medication, Administered: Low Molecular Weight Heparin for VTE Prophylaxis"
    - OR: "Medication, Administered: Injectable Factor Xa Inhibitor for VTE Prophylaxis"
    - OR: "Medication, Administered: Warfarin"
    - OR: "Device, Applied: Intermittent pneumatic compression devices (IPC)"
    - OR: "Device, Applied: Venous foot pumps (VFP)"
    - OR: "Device, Applied: Graduated compression stockings (GCS)"
    - OR:
      - AND:
        
        OR: "Medication, Administered not done: Medical Reason" for "Low Dose Unfractionated Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Low Molecular Weight Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Injectable Factor Xa Inhibitor for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Warfarin "
        
        OR: "Medication, Order not done: Medical Reason" for "Unfractionated Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Warfarin-only ingredient specific "
      - AND:
        
        OR: "Device, Applied not done: Medical Reason" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Applied not done: Medical Reason" for "Venous foot pumps (VFP) "
        
        OR: "Device, Applied not done: Medical Reason" for "Graduated compression stockings (GCS) "
        
        OR: "Device, Order not done: Medical Reason" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Order not done: Medical Reason" for "Venous foot pumps (VFP) "
        
        OR: "Device, Order not done: Medical Reason" for "Graduated compression stockings (GCS) "
    - OR:
      - OR: "Medication, Administered: Unfractionated Heparin (route: 'Intravenous route')"
      - OR: "Laboratory Test, Result: INR (result > 3 )"
      - OR: "Risk Category Assessment: VTE Risk Assessment (result: 'Low Risk')"
      - OR: "Medication, Administered: Direct Thrombin Inhibitor"
      - OR: "Medication, Administered: Glycoprotein IIb/IIIa Inhibitors"
    - OR:
      - OR: "Medication, Administered not done: Patient Refusal" for "Low Dose Unfractionated Heparin for VTE Prophylaxis "
      - OR: "Medication, Administered not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE Prophylaxis "
      - OR: "Medication, Administered not done: Patient Refusal" for "Injectable Factor Xa Inhibitor for VTE Prophylaxis "
      - OR: "Medication, Administered not done: Patient Refusal" for "Warfarin "
      - OR: "Device, Applied not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC) "
      - OR: "Device, Applied not done: Patient Refusal" for "Venous foot pumps (VFP) "
      - OR: "Device, Applied not done: Patient Refusal" for "Graduated compression stockings (GCS) "
    - OR:
      - OR: "Medication, Order not done: Patient Refusal" for "Unfractionated Heparin for VTE prophylaxis ingredient specific "
      - OR: "Medication, Order not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific "
      - OR: "Medication, Order not done: Patient Refusal" for "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific "
      - OR: "Medication, Order not done: Patient Refusal" for "Warfarin-only ingredient specific "
      - OR: "Device, Order not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC) "
      - OR: "Device, Order not done: Patient Refusal" for "Venous foot pumps (VFP) "
      - OR: "Device, Order not done: Patient Refusal" for "Graduated compression stockings (GCS) "
    - <= 1 day(s) starts after end of ("Procedure, Performed: General or Neuraxial Anesthesia" <= 1 day(s) ends after start of "Occurrence A of Encounter, Performed: Encounter Inpatient")
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" <= 1 hour(s) starts after end of "Occurrence A of Encounter, Performed: Emergency Department Visit"
    - AND:
      - OR:
        
        AND:
        
        OR: "Medication, Administered not done: Medical Reason" for "Low Dose Unfractionated Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Low Molecular Weight Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Injectable Factor Xa Inhibitor for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Medical Reason" for "Warfarin "
        
        OR: "Medication, Order not done: Medical Reason" for "Unfractionated Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Medical Reason" for "Warfarin-only ingredient specific "
        
        AND:
        
        OR: "Device, Applied not done: Medical Reason" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Applied not done: Medical Reason" for "Venous foot pumps (VFP) "
        
        OR: "Device, Applied not done: Medical Reason" for "Graduated compression stockings (GCS) "
        
        OR: "Device, Order not done: Medical Reason" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Order not done: Medical Reason" for "Venous foot pumps (VFP) "
        
        OR: "Device, Order not done: Medical Reason" for "Graduated compression stockings (GCS) "
      - OR:
        
        OR: "Medication, Administered not done: Patient Refusal" for "Low Dose Unfractionated Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Patient Refusal" for "Injectable Factor Xa Inhibitor for VTE Prophylaxis "
        
        OR: "Medication, Administered not done: Patient Refusal" for "Warfarin "
        
        OR: "Device, Applied not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Applied not done: Patient Refusal" for "Venous foot pumps (VFP) "
        
        OR: "Device, Applied not done: Patient Refusal" for "Graduated compression stockings (GCS) "
      - OR:
        
        OR: "Medication, Order not done: Patient Refusal" for "Unfractionated Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Patient Refusal" for "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Patient Refusal" for "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific "
        
        OR: "Medication, Order not done: Patient Refusal" for "Warfarin-only ingredient specific "
        
        OR: "Device, Order not done: Patient Refusal" for "Intermittent pneumatic compression devices (IPC) "
        
        OR: "Device, Order not done: Patient Refusal" for "Venous foot pumps (VFP) "
        
        OR: "Device, Order not done: Patient Refusal" for "Graduated compression stockings (GCS) "
      - starts during "Occurrence A of Encounter, Performed: Emergency Department Visit"
  - OR:
    - AND:
      - OR: "Medication, Administered: Oral Factor Xa Inhibitor for VTE Prophylaxis" <= 1 day(s) starts after start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR: "Medication, Administered: Oral Factor Xa Inhibitor for VTE Prophylaxis" <= 1 day(s) starts after end of ("Procedure, Performed: General or Neuraxial Anesthesia" <= 1 day(s) ends after start of "Occurrence A of Encounter, Performed: Encounter Inpatient")
    - AND:
      - OR: "Diagnosis, Active: Atrial Fibrillation/Flutter" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR: "Diagnosis, Inactive: Atrial Fibrillation/Flutter" starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR:
        
        OR: "Procedure, Performed: Hip Replacement Surgery"
        
        OR: "Procedure, Performed: Hip Fracture Surgery"
        
        starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
      - OR:
        
        OR: "Diagnosis, Active: Venous Thromboembolism"
        
        OR: "Diagnosis, Inactive: Venous Thromboembolism"
        
        starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
Denominator Exceptions =
- None

"Device, Applied not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Device, Applied not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Device, Applied not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Device, Applied not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Device, Applied not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Device, Applied not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Device, Applied: Graduated compression stockings (GCS)" using "Graduated compression stockings (GCS) SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.256)"
"Device, Applied: Intermittent pneumatic compression devices (IPC)" using "Intermittent pneumatic compression devices (IPC) SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.214)"
"Device, Applied: Venous foot pumps (VFP)" using "Venous foot pumps (VFP) SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.230)"
"Device, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Device, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Device, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Device, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Device, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Device, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Device, Order: Graduated compression stockings (GCS)" using "Graduated compression stockings (GCS) SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.256)"
"Device, Order: Intermittent pneumatic compression devices (IPC)" using "Intermittent pneumatic compression devices (IPC) SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.214)"
"Device, Order: Venous foot pumps (VFP)" using "Venous foot pumps (VFP) SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.230)"
"Diagnosis, Active: Atrial Fibrillation/Flutter" using "Atrial Fibrillation/Flutter Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.202)"
"Diagnosis, Active: Hemorrhagic Stroke" using "Hemorrhagic Stroke Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.212)"
"Diagnosis, Active: Ischemic Stroke" using "Ischemic Stroke Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.247)"
"Diagnosis, Active: Mental Disorders" using "Mental Disorders Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.262)"
"Diagnosis, Active: Obstetrics" using "Obstetrics Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.263)"
"Diagnosis, Active: Obstetrics VTE" using "Obstetrics VTE Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.264)"
"Diagnosis, Active: Venous Thromboembolism" using "Venous Thromboembolism Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.279)"
"Diagnosis, Inactive: Atrial Fibrillation/Flutter" using "Atrial Fibrillation/Flutter Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.202)"
"Diagnosis, Inactive: Venous Thromboembolism" using "Venous Thromboembolism Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.279)"
"Encounter, Performed: Emergency Department Visit" using "Emergency Department Visit SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.292)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient SNOMEDCT Value Set (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: ICU Admission or Transfer" using "ICU Admission or Transfer SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.305)"
"Intervention, Order: Comfort Measures " using "Comfort Measures SNOMEDCT Value Set (1.3.6.1.4.1.33895.1.3.0.45)"
"Intervention, Performed: Comfort Measures " using "Comfort Measures SNOMEDCT Value Set (1.3.6.1.4.1.33895.1.3.0.45)"
"Laboratory Test, Result: INR" using "INR LOINC Value Set (2.16.840.1.113883.3.117.1.7.1.213)"
"Medication, Administered not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Administered not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Administered not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Administered not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Administered not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Administered not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Administered not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Administered not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Administered: Direct Thrombin Inhibitor" using "Direct Thrombin Inhibitor RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.205)"
"Medication, Administered: Glycoprotein IIb/IIIa Inhibitors" using "Glycoprotein IIb/IIIa Inhibitors RXNORM Value Set (2.16.840.1.113762.1.4.1045.41)"
"Medication, Administered: Injectable Factor Xa Inhibitor for VTE Prophylaxis" using "Injectable Factor Xa Inhibitor for VTE Prophylaxis RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.211)"
"Medication, Administered: Low Dose Unfractionated Heparin for VTE Prophylaxis" using "Low Dose Unfractionated Heparin for VTE Prophylaxis RXNORM Value Set (2.16.840.1.113762.1.4.1045.39)"
"Medication, Administered: Low Molecular Weight Heparin for VTE Prophylaxis" using "Low Molecular Weight Heparin for VTE Prophylaxis RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.219)"
"Medication, Administered: Oral Factor Xa Inhibitor for VTE Prophylaxis" using "Oral Factor Xa Inhibitor for VTE Prophylaxis RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.134)"
"Medication, Administered: Unfractionated Heparin" using "Unfractionated Heparin RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.218)"
"Medication, Administered: Warfarin" using "Warfarin RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.232)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Order: Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific" using "Injectable factor Xa inhibitor for VTE prophylaxis ingredient specific RXNORM Value Set (2.16.840.1.113762.1.4.1021.11)"
"Medication, Order: Low Molecular Weight Heparin for VTE prophylaxis ingredient specific" using "Low Molecular Weight Heparin for VTE prophylaxis ingredient specific RXNORM Value Set (2.16.840.1.113762.1.4.1021.12)"
"Medication, Order: Unfractionated Heparin for VTE prophylaxis ingredient specific" using "Unfractionated Heparin for VTE prophylaxis ingredient specific RXNORM Value Set (2.16.840.1.113762.1.4.1021.13)"
"Medication, Order: Warfarin-only ingredient specific" using "Warfarin-only ingredient specific RXNORM Value Set (2.16.840.1.113762.1.4.1021.10)"
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
"Procedure, Performed: General Surgery" using "General Surgery Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.255)"
"Procedure, Performed: General or Neuraxial Anesthesia" using "General or Neuraxial Anesthesia Grouping Value Set (2.16.840.1.113883.3.666.5.1743)"
"Procedure, Performed: Gynecological Surgery" using "Gynecological Surgery Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.257)"
"Procedure, Performed: Hip Fracture Surgery" using "Hip Fracture Surgery Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.258)"
"Procedure, Performed: Hip Replacement Surgery" using "Hip Replacement Surgery Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.259)"
"Procedure, Performed: Intracranial Neurosurgery" using "Intracranial Neurosurgery Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.260)"
"Procedure, Performed: Knee Replacement Surgery" using "Knee Replacement Surgery Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.261)"
"Procedure, Performed: Urological Surgery" using "Urological Surgery Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.272)"
"Risk Category Assessment: VTE Risk Assessment" using "VTE Risk Assessment LOINC Value Set (2.16.840.1.113883.3.117.1.7.1.357)"
Attribute: "Route: Intravenous route" using "Intravenous route SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.222)"
Attribute: "Result: Low Risk" using "Low Risk SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.400)"
Attribute: "Ordinality: Principal" using "Principal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.14)"
Attribute: "Route: Subcutaneous route" using "Subcutaneous route SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.223)"

eMeasure Title	Venous Thromboembolism Prophylaxis
eMeasure Identifier (Measure Authoring Tool)	108	eMeasure Version number	3
NQF Number	0371	GUID	38b0b5ec-0f63-466f-8fe3-2cd20ddd1622
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 who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission.
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	These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008). The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that “the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism” (Shojania, 2001). Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008). In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated “safe practices” published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006). As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008).
Clinical Recommendation Statement	Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.
Improvement Notation	An increase in rate
Reference	Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387-394.
Reference	Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:381S-453S
Reference	Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2)(Supp):7S-47S
Reference	National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures. A Consensus Report. Washington, DC. NQF; 2006
Reference	Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer; A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality.
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. When low dose unfractionated heparin is not administered due to medical reasons, the intended administration route is subcutaneous. The construct of Unfractionated Heparin (route: 'Intravenous route') intends to capture continually infused heparin rather than heparin flushes or pushes.
Transmission Format	None
Initial Patient Population	Patients age 18 and older discharged from hospital inpatient acute care with a diagnosis of venous thromboembolism (VTE) and a length of stay less than or equal to 120 days.
Denominator	All patients in the initial patient population
Denominator Exclusions	Patients who have a length of stay less than 2 days Patients with comfort measures only documented anytime between arrival and the day after hospital admission Patients with comfort measures only documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day Patients with a principal diagnosis of mental disorders or stroke Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeries
Numerator	Patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given: -the day of or the day after hospital admission -the day of or the day after surgery end date for surgeries that start the day of or the day after hospital admission
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