Measure Information Form

Measure Set: Stroke (STK)

Set Measure ID: STK-1

Performance Measure Name: Venous Thromboembolism (VTE Prophylaxis)

Description: Ischemic or hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission

Rationale: Stroke patients are at increased risk of developing venous thromboembolism (VTE). One study noted proximal deep vein thrombosis in more than a third of patients with moderately severe stroke. Reported rates of occurrence vary depending on the type of screening used. Prevention of VTE, through the use of prophylactic therapies, in at risk patients is a noted recommendation in numerous clinical practice guidelines. For acutely ill stroke patients who are confined to bed, thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH), or fondaparinux is recommended if there are no contraindications. Aspirin alone is not recommended as an agent to prevent VTE.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Ischemic or hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given on the day of or the day after hospital admission.

Included Populations: Not applicable
Excluded Populations: None
Data Elements:

Reason for No VTE Prophylaxis – Hospital Admission

Reason for Oral Factor Xa Inhibitor

VTE Prophylaxis

VTE Prophylaxis Date

Denominator Statement: Ischemic or hemorrhagic stroke patients

Included Populations: Discharges with an ICD-10-CM Principal Diagnosis Code for ischemic or hemorrhagic stroke as defined in Appendix A, Table 8.1 or Table 8.2.
Excluded Populations:

Patients less than 18 years of age

Patients who have a Length of Stay less than 2 days

Patients who have a Length of Stay greater than 120 days

Patients with Comfort Measures Only documented on day of or day after hospital arrival

Patients enrolled in clinical trials

Patients admitted for Elective Carotid Intervention

Data Elements:

Admission Date

Birthdate

Clinical Trial

Comfort Measures Only

Discharge Date

Elective Carotid Intervention

ICD-10-CM Principal Diagnosis Code

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

Adams, H.P., G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, et al. "Guidelines for the Early Management of Adults with Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups." Stroke 38 (2007): 1655-711.
Albers, G. W, P Amarenco, J. D. Easton, R. L. Sacco, and P. Teal. "Antithrombotic and Thrombolytic Therapy for Ischemic Stroke." Chest 119 (2001): 300-20.
Caprini, J. A., and J. I. Arcelus. "State-of the Art Venous Thromboembolism Prophylaxis." SCOPE on Phlebology & Lymphology 1 (2005): 228-40.
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Coull, B. M., L. S. Williams, L. B. Goldstein, J. F. Meschia, D. Heitzman, S. Chaturvedi, K. C. Johnston, et al. "Anticoagulants and Antiplatelet Agents in Acute Ischemic Stroke: Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association)." [In eng]. Stroke 33, no. 7 (Jul 2002): 1934-42.
Desmukh, M., M. Bisignami, P. Landau, and T. J. Orchard. "Deep Vein Thrombosis in Rehabilitating Stroke Patients: Incidence, Risk Factors and Prophylaxis." American Journal Physical Medicine Rehabilitation 70 (1991): 313-16.
Duncan, P. W., R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker. "Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline." [In eng]. Stroke 36, no. 9 (Sep 2005): e100-43.
Geerts, W. H., D. Bergqvist, G. F. Pineo, J. A. Heit, C. M. Samama, M. R. Lassen, C. W. Colwell, and Physicians American College of Chest. "Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)." [In eng]. Chest 133, no. 6 Suppl (Jun 2008): 381S-453S.
Geerts, W. H., J. A. Heit, G. P. Clagett, G. F. Pineo, C. W. Colwell, F. A. Anderson, Jr., and H. B. Wheeler. "Prevention of Venous Thromboembolism." [In eng]. Chest 119, no. 1 Suppl (Jan 2001): 132S-75S.
Geerts, W. H., G. F. Pineo, J. A. Heit, D. Bergqvist, M. R. Lassen, C. W. Colwell, and J. G. Ray. "Prevention of Venous Thromboembolism: The Seventh Accp Conference on Antithrombotic and Thrombolytic Therapy." [In eng]. Chest 126, no. 3 Suppl (Sep 2004): 338S-400S.
Gresham, G. E., P. W. Duncan, W. B. Stason, H. P. Adams, A. M. Adelman, D. N. Alexander, D. S. Bishop et al. "Post-stroke rehabilitation. Clinical practice guideline, no. 16. Rockville, MD: US Department of Health and Human Services." Public Health Service, Agency for Health Care Policy and Research (1995): 95-0062.
Guyatt, G. H., E. A. Akl, M. Crowther, D. D. Gutterman, H. J. Schuunemann, Therapy American College of Chest Physicians Antithrombotic, and Panel Prevention of Thrombosis. "Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines." [In eng]. Chest 141, no. 2 Suppl (Feb 2012): 7S-47S.
Heit, J. A. "The Epidemiology of Venous Thromboembolism in the Community." [In eng]. Arterioscler Thromb Vasc Biol 28, no. 3 (Mar 2008): 370-2.
Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. "Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In Eng]. Stroke (Jan 31 2013).
Kase, C. S., G. W. Albers, C. Bladin, C. Fieschi, A. A. Gabbai, W. O'Riordan, G. F. Pineo, and Prevail Investigators. "Neurological Outcomes in Patients with Ischemic Stroke Receiving Enoxaparin or Heparin for Venous Thromboembolism Prophylaxis: Subanalysis of the Prevention of Vte after Acute Ischemic Stroke with Lmwh (Prevail) Study." [In eng]. Stroke 40, no. 11 (Nov 2009): 3532-40.
Kase, C. S., and G. F. Pineo. "Prevention of Venous Thromboembolism after Ischemic Stroke." [In eng]. Curr Opin Pulm Med 14, no. 5 (Sep 2008): 389-96.
Kelly, J., A. Rudd, R. Lewis, and B. J. Hunt. "Venous Thromboembolism after Acute Stroke." [In eng]. Stroke 32, no. 1 (Jan 2001): 262-7.
Kelly, J., A. Rudd, R. R. Lewis, C. Coshall, A. Moody, and B. J. Hunt. "Venous Thromboembolism after Acute Ischemic Stroke: A Prospective Study Using Magnetic Resonance Direct Thrombus Imaging." [In eng]. Stroke 35, no. 10 (Oct 2004): 2320-5.
Kucher, N., S. Koo, R. Quiroz, J. M. Cooper, M. D. Paterno, B. Soukonnikov, and S. Z. Goldhaber. "Electronic Alerts to Prevent Venous Thromboembolism among Hospitalized Patients." [In eng]. N Engl J Med 352, no. 10 (Mar 10 2005): 969-77.
"Making Healthcare Safer: A Critical Analysis of Patient Safety Practices.". In Evidence Report/Technology Assessment # 43. Rockville, MD: Agency for Healthcare Research and Quality, July 2001.
Michota, F. A. "Venous Thromboembolism Prophylaxis in Medical Patients." [In eng]. Curr Opin Cardiol 19, no. 6 (Nov 2004): 570-4.
Naccarato, M., F. Chiodo Grandi, M. Dennis, and P. A. Sandercock. "Physical Methods for Preventing Deep Vein Thrombosis in Stroke." [In eng]. Cochrane Database Syst Rev, no. 8 (2010): CD001922.
National Heart, Lung, and Blood Institute, and National Institutes of Health. "Stroke Belt Initiative: Project Accomplishments and Lessons Learned." (1996).
Pineo, G., J. Lin, L. Stern, T. Subrahmanian, and L. Annemans. "Economic Impact of Enoxaparin Versus Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Patients with Acute Ischemic Stroke: A Hospital Perspective of the Prevail Trial." [In eng]. J Hosp Med 7, no. 3 (Mar 2012): 176-82.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, et al; on behalf of the American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Jan;49:e37-e38.
Qaseem A., R. Chou, L. L. Humphrey, M. Starkey, P. Shekelle. “Clinical Guidelines Committee of the American College of Physicians. Venous Thromboembolism Prophylaxis In Hospitalized Patients: A Clinical Practice Guideline from the American College of Physicians.” [In eng]. Ann Intern Med 155, no. 9 (Nov 2011): 625-32.
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Stein, P. D., and F. Matta. "Epidemiology and Incidence: The Scope of the Problem and Risk Factors for Development of Venous Thromboembolism." [In eng]. Clin Chest Med 31, no. 4 (Dec 2010): 611-28.
Vergouwen, M. D., Y. B. Roos, and P. W. Kamphuisen. "Venous Thromboembolism Prophylaxis and Treatment in Patients with Acute Stroke and Traumatic Brain Injury." [In eng]. Curr Opin Crit Care 14, no. 2 (Apr 2008): 149-55.
Warlow, C., D. Ogston, and A. S. Douglas. "Deep Venous Thrombosis of the Legs after Strokes. Part I--Incidence and Predisposing Factors." [In eng]. Br Med J 1, no. 6019 (May 15 1976): 1178-81.
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Measure Algorithm:

Specifications Manual for Joint Commission National Quality Measures (v2020A2)
Discharges 01-01-20 (1Q20) through 6-30-20 (2Q20)

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