eMeasure Title

Venous Thromboembolism Discharge Instructions

eMeasure Identifier (Measure Authoring Tool) 110 eMeasure Version number 5.1.000
NQF Number Not Applicable GUID 7fe69617-fa28-4305-a2b8-ceb6bcd9693d
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward The Joint Commission
Measure Developer The Joint Commission
Endorsed By None
Description
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.
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 2004-2015 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
Measure Item Count
Encounter, Performed: Encounter Inpatient
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
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.
Clinical Recommendation Statement
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
Improvement Notation
Improvement noted as an increase in rate
Reference
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.
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
Institute for Clinical Systems Improvement (ICSI). Anticoagulation therapy supplement. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Apr.49p. [91 references]
Reference
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S.
Reference
The Joint Commission. National Patient Safety Goals. Retrieved from the World Wide Web on March 17, 2015. http://www.jointcommission.org/standards_information/npsgs.aspx.
Reference
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.
Definition
None
Guidance
CMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure.

Written information given to the patient is required to address all educational components modeled in the logic as "communication from provider to patient". However, implementers may map a single reference to the educational materials in the EHR to each of the educational components for reporting purposes, as long as:
1. the materials address each and every one of the warfarin education components specified in the eCQM logic;
2. EHR documentation shows that the patient was given a copy of the materials satisfying all the education components (written instructions, as opposed to verbal education).
Transmission Format
TBD
Initial Population
Patients age 18 and older discharged from hospital inpatient acute care during the measurement period with a length of stay less than or equal to 120 days and a diagnosis of venous thromboembolism (VTE)
Denominator
Patients with VTE confirmed through a diagnostic test and discharged to home or court/law enforcement on warfarin therapy
Denominator Exclusions
None
Numerator
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, including compliance with taking the medication and INR monitoring
2. dietary advice, including vitamin K dietary management and recommendation not to change diet
3. follow-up monitoring
4. potential for adverse drug reactions and interactions

Patients who refuse written discharge instructions or other educational material about warfarin.
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
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 Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
eMeasure Venous Thromboembolism (eVTE)