• Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Jun. 91 p. [212 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 (DVT) treated in an outpatient setting.

The priority aim addressed by this measure is to improve quality of care and cost-effectiveness of the 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

Unspecified

Unspecified

Unspecified

Getting Better

Effectiveness

Users of care only

Patients diagnosed with deep vein thrombosis (DVT) who meet the criteria for low-molecular-weight heparin (LMWH)

Identify patients diagnosed with DVT 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 DVT.

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 DVT.

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 (DVT)* treated with LMWH**

*Patients diagnosed with lower extremity DVT 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 DVT 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 (DVT) 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 LMWH-eligible patients with DVT 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); John Heit, MD (Mayo Clinic) (Hematology); Jeff Larsen, MD (River Falls Medical Clinic) (Internal Medicine); Denise Dupras, MD (Mayo Clinic) (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); William Hagen, DO (Altru Health System) (Radiology); Mark Melin, MD (Park Nicollet Health Services) (Vascular Surgery); Amy Murphy, MHHA (Institute for Clinical Systems Improvement) (Measurement/Implementation Advisor); Sherri Huber, MT (ASCP) (Institute for Clinical Systems Improvement) (Facilitator)

Measure was not adapted from another source.

2003 Apr

2007 Jun

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

• Institute for Clinical Systems Improvement (ICSI). Venous thromboembolism. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Jun. 91 p. [212 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 and again on October 8, 2007.

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.