AMERICAN SURGICAL ASSOCIATION
131st Annual Meeting | April 14-16, 2011
The Boca Raton Resort & Club | Boca Raton, Florida
Search Meeting Site Only
Main ASA Website
Annual Meeting Home
Past & Future Meetings

 

 

Back to Annual Meeting Abstracts


Are Higher Hospital Venous Thromboembolism (VTE) Rates an Indicator of Better Quality? Evaluating the Validity of the Hospital VTE Quality Measure Using Clinical Data
Mila H Ju*1, Jeanette W. Chung*1, Christine V. Kinnier*1, David W. Baker*1, David J Bentrem*1, David M. Mahvi1, Clifford Y. Ko2, Karl Y. Bilimoria*1
1Northwestern University, Chicago, IL;2University of California, Los Angeles (UCLA), Los Angeles, CA

OBJECTIVE(S):
Hospital VTE rates are publicly reported and used in pay-for-performance. Prior work suggested surveillance bias: hospitals that look more for VTE with imaging studies find more VTE, thereby incorrectly appear to have worse performance. However, these results have been questioned as the risk-adjustment and VTE measurement relied on administrative data. Our objective was to assess the presence and extent of VTE surveillance bias when using high-quality clinical data.
METHODS:
For 200 hospitals (2009-2010), risk-adjusted postoperative VTE rates (regression models using ACS-NSQIP), VTE imaging use rates (Medicare claims), and VTE prophylaxis adherence (SCIP-VTE-2) were calculated. Hospitals were divided into quartiles by VTE imaging use rates. VTE event and prophylaxis adherence were compared across imaging use quartiles.
RESULTS:
While VTE prophylaxis adherence increased across VTE imaging use quartiles, risk-adjusted VTE rates paradoxically increased (1.1% in the lowest VTE imaging use rate quartile to 1.9% in highest quartile; P<0.001). Hospital VTE imaging use was the strongest predictor of VTE rates (P<0.001). For hospitals in the highest quartile of VTE event rates, 71% had high VTE imaging use rates (i.e., hospitals found more VTE by imaging frequently), while 29% had low imaging use rates (i.e., hospitals with high VTE rate without imaging more frequently - true poor performers).
CONCLUSIONS:
Even when examined with clinically ascertained outcomes and detailed risk adjustment, VTE rates reflect hospital imaging use and perhaps signify vigilant, high-quality care. The VTE outcome measure is not an accurate quality indicator and should not be used in public reporting or pay-for-performance programs.


Back to Annual Meeting Abstracts


© 2018 American Surgical Association. All Rights Reserved. Privacy Policy.