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.

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.

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.

None

None

None

In anticoagulation therapy programs, patient education is a vital component to achieve successful outcomes and reduce the hospital readmission rate. Patients benefit from education about the potential consequences of both their disease and its treatment (Institute for Clinical Systems Improvement 2006). Warfarin is commonly involved in adverse drug events (Ansell, J. 2008). Adverse drug events can include subtherapeutic clot formation, and supertherapeutic hemorrhage. Anticoagulation therapy poses risks to patients due to complex dosing, requisite follow-up monitoring and inconsistent patient compliance. The use of standardized practices for anticoagulation therapy that includes patient/caregiver involvement may reduce the risk of adverse drug events (van Walraven, et. al. 2006). 

The Joint Commission National Patient Safety Goal “Reduce the likelihood of patient harm associated with the use of anticoagulant therapy” states that the organization provides education regarding anticoagulation therapy to patients/family that includes the importance of follow-up monitoring, compliance issues, dietary restrictions, and potential for adverse drug reactions and interactions.

Patients discharged to home on warfarin should be educated on and given written discharge instructions or other educational material regarding compliance issues, dietary advice, follow up monitoring and information about the potential for adverse drug reactions and interactions.

An increase in rate

Ansell J, Hirsch J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: The Eighth ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2008 133:160S-198S.

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.

Institute for Clinical Systems Improvement (ICSI). Anticoagulation therapy supplement. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Apr.49p. [91 references]

The Joint Commission. National Patient Safety Goals. Retrieved from the World Wide Web on September 9, 2011. http://www.jointcommission.org/hap_2011_npsgs/.

Van Walraven, C., Jennings, A., Oake, N., Fergusson, D., and Forster, A.J. Effect of Study Setting on Anticoagulation Control: A Systematic Review and Metagression. Chest 2006; 129; 1155-1166.

None

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. Thes 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.

None

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.

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

None

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

Not Applicable

None

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.