Abstract
Venous thromboembolism (VTE) is a common complication among hospitalized patients. Suboptimal prevention practices have prompted payers to consider hospital-associated VTE as a potentially preventable condition for which financial incentives or penalties exist to drive practice improvement. The authors reviewed all cases of hospital-associated VTE at the Johns Hopkins Hospital between July 1, 2010, and June 30, 2011, that were identified by ICD-9 codes used by a state-run pay-for-performance quality improvement program. Of 157 patients identified as having developed hospital-associated, potentially preventable VTE, only 92 (58.6%) patients developed radiographically confirmed VTE that were potentially preventable. This misclassification of VTE overestimates the marginal additional treatment cost by more than $860 000 and amounts to nearly $200 000 in lost reward in one year alone. ICD-9 codes alone have extremely low positive predictive value to identify true VTE events. The authors recommend linking provision of risk-appropriate prophylaxis to VTE outcomes as a better target for performance improvement.
Original language | English (US) |
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Pages (from-to) | 448-453 |
Number of pages | 6 |
Journal | American Journal of Medical Quality |
Volume | 31 |
Issue number | 5 |
DOIs | |
State | Published - Sep 1 2016 |
Keywords
- ICD-9
- pay for performance
- quality improvement
- venous thromboembolism
ASJC Scopus subject areas
- Health Policy