University of Illinois at Chicago College of Pharmacy. Hospital Compliance with Proposed JCAHO Performance Measures for VTE

Transcription

1 1 Hospital Compliance with Proposed JCAHO Performance Measures for VTE Vikrant Vats, PhD Post Doc Research Associate Center of Pharmacoeconomic Research

2 Background/Rationale Venous thromboembolism (VTE) is a serious and a common medical problem in the US More than 600,000 symptomatic VTE events occur annually in the US resulting in 296,370 deaths Pulmonary embolism (PE) is the single largest preventable cause of death in hospitals Prevention and treatment of VTE has been widely studied and consensus guidelines published Nevertheless, such guidelines are underutilized in clinical practice and therefore quality of VTE care may be suboptimal 2

3 Background/Rationale Standardized performance measures do not exists that assess the quality of care for VTE patients The National Quality Forum (NQF) in association with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed National Consensus Standards for Prevention and Care of VTE patients in 2004 Final measures are expected to be released by early 2008 Because these measures are untested, it is not known how feasible they are to measure or how hospitals will perform 3

4 Study Objective To assess baseline performance on selected JCAHO measures for prevention and treatment of VTE 1. Objective confirmation of clinically suspected VTE 2. Anticoagulation overlap of parenteral & warfarin for VTE pt 3. VTE patients with therapeutic INR 4. Platelet count monitoring for pts with VTE receiving UFH 5. VTE pts with CrCl <30 ml/min that received dosage 6. UFH management by nomogram/protocol for VTE pt 7. VTE treatment for discharged patients with active cancer 8. VTE patient education 4

5 Methods Study Design/Sample Cross-sectional sectional observational study Voluntary/convenience sample from Consorta member hospitals Consorta Inc. is a leading healthcare resource management and a group purchasing organization Majority of the members are faith-based or non-profit health systems 224 hospitals were invited to participate in the study 32 hospitals volunteered to participate in the study 5

6 Methods Data Collection Retrospective chart review was performed by practicing pharmacists at each hospital Participants were encouraged to submit at least 10 but preferably 30 case reports per hospital Cases included only those who received anticoagulant therapy for prophylaxis or treatment of VTE between January 1, 2006 to May 31, 2006 Data was collected using an online 45 item- standardized medication use evaluation form 6

7 7

8 Results Demographics Result Number of hospitals 32 Total number of cases 902 Mean number of cases per hospital 28.2 Mean age of patients 67.7 ±16.9 Active cancer (%) 104 (11.5%) Prophylaxis of VTE (%) 732 (81.2%) Treatment of VTE (%) 170 (18.8%) Mean length of therapy 5.7 ± 5.3 Mean length of hospital stay 7.8 ± 7.2 8

9 Results 1. Objective confirmation of clinically suspected VTE = Cases treated for acute VTE confirmed with a validated, objective diagnostic test within 72 hrs of initiation of therapy Cases treated for acute VTE = 82.9% (170) 9

10 Results JCAHO Performance Measure 2. Anticoagulation overlap of parenteral & warfarin for VTE patients 3. VTE patients with therapeutic INR for 2 days prior to discontinuation of parental anticoagulant % (n) 67.3 (168) 28.0 (168) 10

11 Results JCAHO Performance Measure 4. UFH management by nomogram/protocol for VTE patients 5. Platelet count monitoring for VTE patient receiving unfractionated heparin 6. VTE patients with renal impairment (CrCl <30 ml/min) that received reduced dosage of LMWH % (n) 96.2 (78) 33.5 (176) 30.4 (79) 11

12 Results JCAHO Performance Measure 7. VTE treatment for discharged patients with active cancer % (n) 14.7 (95) 8. VTE education (inpatient) 44.3 (395) 12

13 Discussion JCAHO initiated the process with 19 performance measures and currently 8 measures are being evaluated at 55 US hospitals Our experience suggests it is practical to assess and track data for these measures Performance on some measures was less than optimal particularly Patient education Extended LMWH treatment in patients with cancer Dose adjustment in patients with renal impairment Appropriate overlap/bridging therapy 13

14 Discussion These results may help inform accrediting organizations or pay-for for-performance programs about the initial performance thresholds that may be appropriate These results may inform hospitals as to areas to direct quality improvement efforts in preparation for future requirements for monitoring performance in this area The final measures will be important in JCAHO accreditation for institutions Quality data compare between institutions Pay for performance via NQF/CMS 14

15 Limitations The investigators did not validate the data that were abstracted from medical records and reported by each site Cases that were abstracted by each site were selected in a quasi-random fashion Hospitals volunteered to participate thus there is a possibility of selection bias 15

16 Conclusion Hospitals involved were able to feasibly collect and report data necessary for assessment of selected JCAHO VTE performance measures Performance on these measures ranged from % (with 100% being ideal) Results can inform hospitals, accrediting organizations, and payers on future use of these measures 16

17 Research Team Principal Investigator Co- Investigators : Glen Schumock, Pharm.D, MBA 1 : Edith Nutescu, Pharm.D 1 : Jeff Wojtynek, Pharm.D 2 : John Theobald, Pharm.D 2 1 University of Illinois at Chicago, College of Pharmacy, Chicago, IL 2 Consorta Inc, Schaumburg, IL 17