Johns Hopkins: Blood clot penalties may be unfairly imposed

Financial penalties imposed on Maryland hospitals based solely on the total number of patients who suffer lung or leg blood clots should be re-evaluated, according to research from the Johns Hopkins University School of Medicine in Baltimore.

"Our study of patients just at The Johns Hopkins Hospital identifies a need to dramatically re-evaluate the venous thromboembolism outcome and process measures," said Elliott R. Haut, MD, PhD. "Nearly half of the [VTE] events identified by the state program in the records we reviewed were not truly preventable, because patients received best practice prevention and still developed blood clots."

If the findings of the study hold true across other hospitals in Maryland and the nation for VTE and similar events, Dr. Haut argues "millions of dollars may be at risk inappropriately for hospitals."

For the study, Dr. Haut and his team reviewed case records for 128 patients treated between July 2010 and June 2011 who developed hospital-acquired VTE, all of which were flagged by the Maryland Hospital Acquired Conditions pay-for-performance program. The researchers then searched for evidence that all of the clots could have been prevented.

They found:

1. Thirty-six patients (28 percent) had nonpreventable, catheter-related deep vein thrombosis.

2. Ninety-two patients (72 percent) had clots that were potentially preventable with medicine.

3. Of those with medicinally preventable clots, 45 had a clot in the leg, 43 had clot in the lungs and four patients had both types of clots.

4. Seventy-nine (86 percent) of the 92 patients were prescribed optimal clot-preventing medications, but only 43 (47 percent) received "defect-free care."

5. Of the 49 patients (53 percent) who received suboptimal care, 13 (27 percent) were not prescribed risk-appropriate clot-preventing drugs and 36 (73 percent) missed at least one dose of appropriately prescribed medication.

"To reduce preventable harm, policymakers need to re-evaluate how they penalize hospitals and improve the measures they use to assess VTE prevention performance," said Dr. Haut. "In addition, clinicians need to ensure that patients receive all prescribed preventive therapies."



More articles on blood clots and VTE:
Patient safety tool: Video, handout on blood clot prevention
Dr. Peter Pronovost: Dangerous blood clots tend to fly 'under the radar' in hospitals
VTE rates unchanged despite increase in use of prevention therapies

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