Key result
Novel quality measure unmasks VTE chemoprophylaxis failure in ~18% of colectomy patients versus standard SCIP-VTE-2.
Why the study?
Current VTE quality measures are inadequate and do not comprehensively capture failures in postoperative VTE chemoprophylaxis throughout patients' entire hospitalization.
Observational (n=4,086)
Yes
A novel comprehensive quality measure identified significantly more VTE chemoprophylaxis failures (18%) compared to standard SCIP-VTE-2 measures (0-3%) in colectomy patients, highlighting the need for improved prophylaxis throughout hospitalization.
OBJECTIVES: The aims of this study were to: (1) measure the rate of failure to provide defect-free postoperative venous thromboembolism (VTE) chemoprophylaxis, (2) identify reasons for failure to provide defect-free VTE chemoprophylaxis, and (3) examine patient- and hospital-level factors associated with failure. SUMMARY BACKGROUND DATA: Current VTE quality measures are inadequate. VTE outcome measures are invalidated for interhospital comparison by surveillance bias. VTE process measures (e.g., SCIP-VTE-2) do not comprehensively capture failures throughout patients' entire hospitalization. METHODS: We examined adherence to a novel VTE chemoprophylaxis process measure in patients who underwent colectomies over 18 months at 36 hospitals in a statewide surgical collaborative. This measure assessed comprehensive VTE chemoprophylaxis during each patient's entire hospitalization, including reasons why chemoprophylaxis was not given. Associations of patient and hospital characteristics with measure failure were examined. RESULTS: The SCIP-VTE-2 hospital-level quality measure identified failures of VTE chemoprophylaxis in 0% to 3% of patients. Conversely, the novel measure unmasked failure to provide defect-free chemoprophylaxis in 18% (736/4086) of colectomies. Reasons for failure included medication not ordered (30.4%), patient refusal (30.3%), incorrect dosage/frequency (8.2%), and patient off-unit (3.4%). Patients were less likely to fail the chemoprophylaxis process measure if treated at nonsafety net hospitals (OR 0.62, 95% CI 0.39-0.99, P = 0.045) or Magnet designated hospitals (OR 0.45, 95% CI 0.29-0.71, P = 0.001). CONCLUSIONS: In contrast to SCIP-VTE-2, our novel quality measure unmasked VTE chemoprophylaxis failures in 18% of colectomies. Most failures were due to patient refusals or ordering errors. Hospitals should focus improvement efforts on ensuring patients receive VTE prophylaxis throughout their entire hospitalization.
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Yang et al. (2019) conducted an observational in Patients undergoing colectomies (n=4,086). Novel VTE chemoprophylaxis process measure vs. SCIP-VTE-2 hospital-level quality measure was evaluated on Failure to provide defect-free VTE chemoprophylaxis. A novel quality measure unmasked failure to provide defect-free VTE chemoprophylaxis in 18% of colectomy patients, compared to 0% to 3% identified by the standard SCIP-VTE-2 measure.
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