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Financial penalties for hospital-acquired VTE do not account for unpreventable incidents
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Imposing financial penalties based solely on the total number of patients who experience venous thromboembolism failed to account for incidents that occurred despite the consistent and proper use of the best preventive strategies, according to the results of a retrospective analysis.
“We have a big problem with current pay-for-performance systems based on ‘numbers-only’ total counts for clots,” Elliott R. Haut, MD, PhD, associate professor of surgery at The Johns Hopkins University School of Medicine and associate professor of health policy and management at The Johns Hopkins Armstrong Institute for Patient Safety and Quality, said in a press release. “Even when hospitals do everything they can to prevent VTE events, they are still being dinged for patients who develop these clots.”
National and regional entities impose financial penalties for hospitalized patients who develop VTE despite evidence that not all VTE events are preventable, even with prophylaxis, according to the researchers.
Haut and colleagues conducted a retrospective review of patients with hospital-acquired VTE identified by the Maryland Hospital Acquired Conditions initiative at The Johns Hopkins Hospital between 2010 and 2011.
The researchers used electronic health records to determine patient risk assessments for VTE, prescription of risk-appropriate prophylaxis and pharmacological prophylaxis administration. They excluded patients with catheter-associated deep vein thrombosis, because the condition is not preventable through prophylaxis administration.
During the study period, 128 patients developed hospital-acquired VTE 28% (n = 36) of whom had catheter-associated DVT.
The remaining 92 patients (mean age, 60.6 years; 47% women) developed potentially preventable VTEs. Forty-five patients developed DVT only, 43 patients developed pulmonary embolism only and four patients developing both conditions.
The researchers observed that 86% (n = 79) of patients received a prescription for optimal prophylaxis; however, only 47% (n = 43) received defect-free care, or the receipt of all doses of risk-appropriate VTE prophylaxis as recommended by a validated, mandatory clinical decision support tool prior to VTE diagnosis.
Among the 49 patients who received suboptimal care, 13 patients did not receive a prescription for risk-appropriate VTE prophylaxis. The remaining 36 patients (73%) missed at least one dose of appropriately prescribed prophylaxis.
No difference in suboptimal care patterns occurred between surgically treated and medically treated patients.
“Nearly half of the VTE events identified by the state program in the records we reviewed were not truly preventable, because patients received best practice prevention and still developed blood clots,” Haut said. “To reduce preventable harm, policymakers need to re-evaluate how they penalize hospitals and improve the measures they use to assess VTE prevention performance. In addition, clinicians need to ensure that patients receive all prescribed preventive therapies.” – by Cameron Kelsall
Disclosure: Haut reports research support from the Patient-Centered Outcomes Research Institute, royalties from the publishing firm Lippincott, Williams & Wilkins and compensated expert witness testimony for multiple medical malpractice cases. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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