Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant health concern in US hospitals, affecting 350,000 to 600,000 patients annually. A leading cause of avoidable hospital deaths and post-surgical readmissions, VTE prevention is crucial for patient safety and cost-effective care.
To address this, healthcare organizations are prioritizing critical interventions such as mechanical prophylaxis, with electronic Clinical Quality Measures (eCQMs) playing a key role in tracking and reporting VTE prophylaxis and hospital-associated VTE (HA-VTE) rates.
Tracking VTE with CMS Electronic Clinical Quality Measures (eCQMs)
The Centers for Medicare & Medicaid Services (CMS) guides hospitals in tracking and reporting on VTE through specific eCQMs, focusing on harm reduction and improved patient safety. These measures are part of CMS’s broader initiative to enhance patient safety and care quality by monitoring and reducing the incidence of hospital-acquired conditions, such as VTE.
Two key measures are:
- Hospital Harm – Postoperative Venous Thromboembolism eCQM: This measure assesses the proportion of patients (aged 18 and above) who develop at least one post-operative VTE event, such as a PE or DVT, during a hospital encounter, serving as an indicator of care quality and incentivizing hospitals to improve care processes.
- CMS108v11: Venous Thromboembolism Prophylaxis: This eCQM assesses whether patients receive VTE prophylaxis or have documented reasons for not receiving it, aiming to prevent VTE and its complications.
The Importance of VTE Prophylaxis
Up to 70% of VTE cases among hospitalized patients are preventable, yet fewer than half receive adequate preventive treatment. Effective VTE prophylaxis protocols can significantly reduce hospital mortality and morbidity.
There are two primary categories of VTE prophylaxis:
- Pharmacological prophylaxis: Anticoagulant medications to inhibit blood clotting, such as Low Molecular Weight Heparins (LMWHs)
- Mechanical prophylaxis: Techniques to promote venous blood flow and reduce blood clot risk , such as intermittent pneumatic compression (IPC) devices
Mechanical Prophylaxis: A Key Component of VTE Prevention
Mechanical prophylaxis is an integral part of VTE prevention, particularly when pharmacological options are contraindicated or in patients at mid-to-low risk who may not require medication. A combination of both mechanical and pharmacological interventions can also effectively reduce the risk of VTE in some cases. (See our recent blog to learn more on this.)
IPC devices are widely accepted as a standard of care for mechanical VTE prophylaxis, but nonadherence remains a challenge. While studies show IPC devices can effectively reduce the risk of VTE, reported compliance rates are often as low as 40%. Discomfort is also a primary factor, making it difficult for patients to achieve the recommended wear time of 18-22 hours per day.
Enhancing VTE Prevention and Tracking with Data-Driven Insights
Hospitals can also enhance VTE prevention strategies and patient outcomes by analyzing data to develop more effective strategies to reduce the incidence of VTE. However, despite the critical importance of VTE prevention, the integration of eCQMs presents challenges, including reliance on documentation that may not accurately reflect prophylactic measures. Addressing these issues requires a more concerted effort in data collection to ensure accuracy and provide meaningful insights.
Key Metrics for VTE Prevention
Obtaining critical metrics, such as prophylaxis prevalence and hospital-associated VTE incidence, is essential for effective VTE prevention. A data-driven approach can significantly enhance this process by:
- Providing accurate documentation of patient mobility levels and wear time compliance
- Empowering healthcare providers to make informed decisions that improve patient outcomes and care quality
- Enabling bedside caregivers to support adherence to the recommended 18-22 hours of VTE prophylaxis
- Helping hospitals to facilitate early mobilization, refine prevention protocols, reduce complications and length of stay, and lower healthcare costs
By leveraging data-driven insights, hospitals can optimize their VTE prevention strategies, drive quality improvement, and ultimately deliver better patient outcomes.
Innovations in Mechanical Prophylaxis
Despite its effectiveness, VTE prophylaxis remains underused or is used sub optimally in both medical and surgical patients. This is largely due to the current standard of care, where IPC devices often fail to meet patients’ needs due to significant limitations that impact their effectiveness and safety. (Learn more here) New technologies, such as wearable mobile compression devices, offer promising solutions to overcome the limitations of traditional IPC devices.
Wearable Compression Technology
One novel approach to VTE prevention that’s gaining traction, backed by evidence-based research, is the Movement And Compressions (MAC) System. The MAC System is a battery-operated, cordless, and tubeless wearable therapeutic compression device that provides compressions to the calf muscles using force instead of air to increase venous blood flow and reduce the risk of clot formation.
An integrated display highlights individual patient mobility data, including compliance (wear time), time in bed, time upright (such as time spent sitting a chair or dangling at the side of the bed), and number of steps taken, with seamless integration capabilities into electronic medical record (EMR) to streamline data tracking and inform care decisions. Up to 48 hours of patient data are available to empower bedside caregivers with critical metrics to support the execution of in-hospital mobility and adherence to the recommended 18-22 hours of VTE prophylaxis.
Its innovative design addresses many limitations of traditional IPC devices, enhancing early mobilization efforts and improving patient outcomes. It is the only known portable, non-pneumatic compression device that also measures and displays patient mobility data, along with its EMR integration capabilities, currently available in the clinical setting.
Benefits of the MAC System include:
- Measures and tracks patient mobility data and adherence to VTE prophylaxis, providing accurate documentation with actionable insights for bedside caregivers Achieves target peak blood flow velocity 3x over baseline across all BMIs using force instead of air to provide consistent compressions that mimic ambulation
- Enhances patient mobility and comfort, with significantly longer wear times and improved patient satisfaction
Evidence-Based Research Supporting the MAC System
Studies have shown that wearable therapeutic compression devices like the MAC System can lead to:
- Significantly longer wear times, with more patients wearing the device for at least 18 hours per day
- Improved patient comfort and satisfaction with meeting mobility goals
- Enhanced clinical usability with accurate documentation of patient mobility levels
- Reduced incidence of VTEs and improved patient safety
A recent Quality Improvement (QI) project reported a 92% increase in compliance and a reduction in VTE incidence over a 7-month period using the MAC System.
The accurate and actionable data provided by wearable compression devices, such as the MAC system, can help hospitals overcome the limitations of traditional data collection methods and improve their eCQM reporting. As hospitals adopt these new technologies, they can enhance their VTE prevention strategies while meeting CMS reporting requirements and driving quality improvement initiatives, ultimately leading to better patient outcomes.
Preparing for CMS eCQM Compliance and Harm Reduction
As CMS continues to prioritize harm reduction measures, hospitals must stay ahead of the curve by implementing effective strategies for VTE prevention. To meet CMS reporting requirements and improve patient outcomes, hospitals should focus on the following:
- Developing and implementing evidence-based VTE prophylaxis protocols
- Tracking and reporting VTE rates using eCQMs
- Analyzing data to identify areas for improvement and drive quality initiatives
By prioritizing VTE prevention, harm reduction, and leveraging solutions such as wearable compression devices with data-driven insights, hospitals can enhance patient safety, reduce VTE incidence, and improve care quality.