New Standards for DVT coming

November 21, 2005

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are on the way out. Not the conditions, which represent one of the most significant causes of hospital-associated morbidity and mortality, but the names. The familiar terms DVT and PE are being replaced with a broader term, venous thromboembolism, or VTE.

The new name is the most visible step in the creation of consensus practice standards for the prevention and treatment of VTE by the National Quality Forum and the Joint Commission on Accreditation of Healthcare Organizations. NQF and JCAHO are launching the new term slowly. For now, both groups are referring to DVT and DVT/VTE, but the emphasis will shift to VTE.

According to the Agency for Healthcare Research and Quality, VTE refers to all forms of pathologic thrombosis occurring on the venous side of the circulation. DVT of the lower extremities is the most common presentation of VTE.

PE may remain in common usage because it is the proximate cause of death for about 200,000 hospital patients annually in the United States alone.

If the joint VTE performance measures project is successful, Sprenger said the resulting practice measures could be incorporated into future JCAHO performance measurement activities.

According to NQF, about two million Americans suffer VTE annually. Some 600,000 patients progress to PE, and a third of them die. Current estimates suggest that only 30% to 40% of patients who should re-ceive VTE prophylaxis actually get it, noted NQF spokesman Phil Dunn.

In 2003, NQF endorsed Safe Practice 17, which calls for universal evaluation for VTE risk upon hospital admission and at regular intervals thereafter. Patients at risk for VTE should be given appropriate prophylaxis. The VTE project is designed to turn Safe Practice 17 into best practices for the prevention and treatment of VTE. Specific performance measures set the stage to evaluate provider adherence to best practices.

"We are trying to set up national standards to prevent and treat VTE," said Edith Nutescu, Pharm.D., director of the Antithrombosis Clinic at the University of Illinois at Chicago College of Pharmacy. She is the pharmacy representative on NQF's VTE steering committee. Another pharmacist sits on the VTE technical advisory panel. "Many patients are asymptomatic," she explained. "We are just starting to recognize the degree of morbidity and mortality associated with this disease. If JCAHO makes these performance measures into a survey standard, we will have a major impact."

NQF created the steering committee that is directing the scope and direction of the VTE project. The body subcontracted the VTE technical advisory panel, or TAP, to JCAHO.

The TAP's call for preliminary measures got 19 responses from healthcare organizations around the country, said associate project director Harriet Gammon, who oversees JCAHO's side of the effort. TAP members are currently evaluating existing measures and clinical evidence. The group will forward preliminary recommendations to the steering committee later this year.

The steering committee will select an initial set of performance measures and post them for public comment, a typical step in the JCAHO process. After the comment period and any necessary adjustments, the initial measures will go through a two-step field test. If all goes as planned, the consensus performance measures will be released in late 2007 or early 2008.

"NQF and JCAHO are putting their different processes together," Gammon said. "When all is said and done, we will have a set of very usable measures. JCAHO will create the expectation that these measures be put into practice."