• Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism diagnosis and treatment. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2009 Feb. 79 p. [220 references]

Does not apply to this measure

This measure is used to assess the percentage of low-molecular-weight heparin (LMWH)-eligible patients with deep vein thrombosis treated in an outpatient setting.

The priority aim addressed by this measure is to improve accurate diagnosis and treatment of venous thromboembolism (VTE).

Venous thromboembolism (VTE); deep vein thrombosis (DVT); low-molecular-weight heparin (LMWH)

Number of low-molecular-weight heparin (LMWH)-eligible patients with deep vein thrombosis (DVT) treated with LMWH (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Number of low-molecular-weight heparin (LMWH)-eligible patients with deep vein thrombosis (DVT) treated as outpatients (see the related "Numerator Inclusions/Exclusions" field in the Complete Summary)

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement

Physician Group Practices/Clinics

Physicians

Group Clinical Practices

Age greater than or equal to 18 years

Either male or female

Unspecified

Unspecified

Unspecified

Complications or comorbidities of venous thromboembolism (VTE) include massive pulmonary embolism, contraindications to anticoagulation, known history of heparin-induced thrombocytopenia, extensive iliofemoral thrombosis/phlegmasia, pregnancy, familial bleeding disorders, and severe renal dysfunction.

• Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism diagnosis and treatment. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2009 Feb. 79 p. [220 references]

Unspecified

Unspecified

Getting Better

Effectiveness

Users of care only

Patients age 18 years and older diagnosed with deep vein thrombosis who meet the criteria for low-molecular-weight heparin (LMWH)

Identify patients diagnosed with deep vein thrombosis using the specified diagnosis codes (see the "Denominator Inclusions/Exclusions" field). Some medical groups will be able to identify the population of patients through patient computer records of International Classification of Diseases, Ninth Revision (ICD-9) codes. If this is not possible, a list of patients may be generated from the radiology records for compression ultrasounds with a diagnosis of deep vein thrombosis.

The medical record of each patient is reviewed to determine if the patient meets any of the exclusion criteria (see the "Denominator Inclusions/Exclusions" field). If none of the exclusions are met, the chart is further reviewed for administration of LMWH.

Finally, the chart is reviewed for an inpatient admission within 7 days of the diagnosis of deep vein thrombosis.

The suggested time frame for data collection is a calendar month.

Patients associated with provider

Inclusions
Number of low-molecular-weight heparin (LMWH)-eligible patients with deep vein thrombosis* treated with LMWH**

*Patients diagnosed with lower extremity deep vein thrombosis as identified by the following International Classification of Diseases, Ninth Revision (ICD-9) codes: 451.11, 451.19, 451.2, 453.8.

**Patients treated with LMWH: listed with GCN code 7542.

Exclusions
Patients are excluded for any of the following conditions:

• Any deep vein thrombosis other than lower extremity
• Suspected or confirmed pulmonary embolus
• Contraindications to anticoagulation
• Familial bleeding or clotting disorders
• History of heparin-induced thrombocytopenia
• Pregnancy
• Phlegmasia/extensive iliofemoral disease
• Renal dysfunction requiring dialysis

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Therapeutic Intervention

Time window brackets index event

Inclusions
Number of low-molecular-weight heparin (LMWH)-eligible patients with deep vein thrombosis treated as outpatients*

*Include patients who do not have an inpatient admission within 7 days of diagnosis. Do not consider stays in observation units as inpatient admission.

Exclusions
Unspecified

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Fixed time period

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Percentage of patients with deep vein thrombosis who are treated in an outpatient setting.

Institute for Clinical Systems Improvement

The following Minnesota health plans provide direct financial support: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne and UCare Minnesota. In-kind support is provided by the Institute for Clinical Systems Improvement's (ICSI) members.

Work Group Members: Bruce Burnett, MD (Work Group Leader) (Park Nicollet Health Services) (Internal Medicine); Mary Michener, MD (Winona Clinic) (Family Medicine); Denise Dupras, MD (Mayo Clinic) (Internal Medicine); Thomas Gabert, MD, MPH (Marshfield Clinic) (Internal Medicine); Seema Maddali, MD, MPH (Fairview Health Services) (Internal Medicine); Cindy Felty, NP (Mayo Clinic) (Nursing and Health Education); Peter Marshall, PharmD (HealthPartners Health Plan) (Pharmacy); Keith Harmon, MD (Park Nicollet Health Services) (Pulmonology); Mark Melin, MD (Park Nicollet Health Services) (Vascular Surgery); Penny Fredrickson (Institute for Clinical Systems Improvement) (Facilitator); Myounghee Hanson (Institute for Clinical Systems Improvement) (Facilitator)

ICSI has adopted a policy of transparency, disclosing potential conflict and competing interests of all individuals who participate in the development, revision and approval of ICSI documents (guidelines, order sets and protocols). This applies to all work groups (guidelines, order sets and protocols) and committees (Committee on Evidence-Based Practice, Cardiovascular Steering Committee, Women's Health Steering Committee, Preventive & Health Maintenance Steering Committee and Respiratory Steering Committee).

Participants must disclose any potential conflict and competing interests they or their dependents (spouse, dependent children, or others claimed as dependents) may have with any organization with commercial, proprietary, or political interests relevant to the topics covered by ICSI documents. Such disclosures will be shared with all individuals who prepare, review and approve ICSI documents.

No work group members have potential conflicts of interest to disclose.

Measure was not adapted from another source.

2003 Apr

2009 Feb

This is the current release of the measure.

This measure updates a previous version: Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Jun. 91 p.

• Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism diagnosis and treatment. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2009 Feb. 79 p. [220 references]

This NQMC summary was completed by ECRI on February 9, 2004. This NQMC summary was updated by ECRI Institute on July 27, 2004, July 20, 2005, May 1, 2006, October 8, 2007, and again on June 30, 2009.

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.