Development and Testing of a Risk Standardized Venous Thromboembolism/Major Bleeding Electronic Clinical Quality Measure

Troy Li, BS
Department of Medicine
Division of General Internal Medicine and Primary Care
Poster Overview

Patients who get Hip and Knee replacement surgeries are at a higher risk of developing blood clots after surgery. These blood clots are dangerous. They can lead to additional hospital visits and even death. In order to prevent clots, doctors often prescribe blood-thinning drugs. However, these drugs can cause dangerous bleeding. To help prevent these problems, we created a tool to help doctors track how often their patients have clotting and bleeding events. To test this tool, we looked at all the Mass General Brigham hip and knee surgeries over the past 4 years. We found that the tool is useful locally. Our next goal will to be to test our tool at another large healthcare system.

Scientific Abstract

Background: Research has shown that patients undergoing Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are at a high risk of developing Venous Thromboembolism (VTE) without the prophylactic use of anticoagulants. However, anticoagulation can subsequently put patients at increased risk for experiencing a major bleeding event. The precarious balance between over and under coagulation led our research team to develop a composite measure that evaluates both risk-standardized VTE and major bleeding rates.

Methods: Utilizing Mass General Brigham’s EHR data, we generated multiple ICD10 value sets that allowed us to identify VTE and Major Bleeding events following a THA/TKA procedure. After reviewing existing clinical guidelines and receiving approval from our Technical Expert Panel, we decided on a timeframe of 35-days post-operation as the cutoff for tracking these adverse surgical events.

Results: Internal testing within the MGB Healthcare System (>17,000 Procedures) indicated an overall unadjusted VTE/Bleeding rate of 4.11% (Major Bleeding – 3.55% and VTE – .56%). When the data was analyzed at the clinician group level, significant variation in the complication rate was observed between groups.

Next Steps: We are collaborating with a geographically distant healthcare system to conduct additional testing and to analyze the meaningfulness and generalizability of our eCQM.

 

Clinical Implications
This measure will assist healthcare providers personalize care by identifying the appropriate VTE prophylactic regimen that balances each patient’s risk of VTE and risk of major bleeding.
Research Areas
Authors
Troy Li, BS, Avery Pullman, BS, Woongki Kim, BS, Alexandra Businger MPH, Stuart Lipsitz, ScD, Ania Syrowatka, PhD, Michael Sainlaire, MS, Tien Thai, BS, David W. Bates, MD, MSc, Patricia Dykes PhD, MA, RN
Principal Investigator
David W. Bates, MD, MSc

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