title: ICD-9 Code-Based Venous Thromboembolism Performance Targets Fail to Measure Up.
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.
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD Johns Hopkins Bloomberg School of Public Health, Baltimore, MD blau2@jhmi.edu.
authors.forename: Brandyn D
authors.initials: BD
authors.lastname: Lau
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Hobson
authors.affiliation: The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Peggy S
authors.initials: PS
authors.lastname: Kraus
authors.affiliation: The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Chepkorir
authors.initials: C
authors.lastname: Maritim
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Austin
authors.affiliation: The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Shermock
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Bhunesh
authors.initials: B
authors.lastname: Maheshwari
authors.affiliation: The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Paul X
authors.initials: PX
authors.lastname: Allen
authors.affiliation: The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Aileen
authors.initials: A
authors.lastname: Almario
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, MD The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
mesh_terms: D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D038801:International Classification of Diseases / Q000592:standards; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control
keywords: ICD-9; pay for performance; quality improvement; venous thromboembolism