Is the Meaningful Use Venous Thromboembolism VTE-6 Measure Meaningful? A Retrospective Analysis of One Hospital's VTE-6 Cases.

BACKGROUND: Venous thromboembolism (VTE) is a common, often deadly cause of preventable harm for hospitalized patients. The Centers for Medicare & Medicaid Services Meaningful Use VTE-6 measure automatically captures data documented in a Meaningful Use-certified electronic health record (EHR) to identify patients with potentially preventable VTE, defined as those who developed radiologically confirmed, in-hospital VTE and did not receive prophylaxis between admission and the day prior to the diagnostic test order date. The validity of the Meaningful Use VTE-6 measure was assessed by reviewing the quality of VTE prophylaxis provided to patients identified by the measure.

METHODS: A retrospective chart review was performed on all patients identified by VTE-6 during the first year of Meaningful Use Stage 1. The following information was abstracted from the Meaningful Use-certified EHR: patient demographics, clinical data, VTE prophylaxis prescribed and administered, and diagnostic testing. These data were then analyzed to assess prevention efforts prior to each VTE event and identify potential targets for improvement.

RESULTS: Fifteen patients were identified as having sustained potentially preventable VTE by the Meaningful Use VTE-6 measure. Nine (60%) of the 15 patients identified were false positives and did not meet the rationale of the measure. For only 6 (40%) of the 15 patients was VTE considered to be truly potentially preventable; those patients provided targets for quality improvement measures.

CONCLUSIONS: The majority of patients identified by the Meaningful Use VTE-6 algorithm did not suffer truly potentially preventable VTE. Misclassification of VTE as "potentially preventable" hinders efforts to target true opportunities for quality improvement.