Evidence-Based Guidelines

According to guideline recommendations of the American College of Chest Physicians (ACCP)*1

Patients undergoing total knee replacement (TKR) or total hip replacement (THR) surgery should receive VTE prophylaxis with an appropriate antithrombotic agent for a minimum of 10 to 14 days; for patients undergoing major orthopedic surgery, prophylaxis should continue for up to 35 days

VTE Performance Measures

National Voluntary Consensus Standards for Prevention and Care of VTE‡3

The National Quality Forum (NQF) has endorsed this and other performance measures for managing VTE in the hospital setting

Measure Assessment

VTE discharge instructions

The number of patients who are discharged to home, home care, or home hospice on an oral anticoagulant with written discharge instructions that address topics including monitoring, compliance, and potential adverse drug reactions/interactions

*Adapted from 2012 ACCP guidelines. See guidelines for full recommendations: Guyatt GH, et al. Chest. 2012;141 (2 Suppl):7S-47S. † Adapted from AAOS Clinical Practice Guideline and Evidence Report. Please see complete text for details at http://www.aaos.org/research/guidelines/VTE/VTE_full_ guideline.pdf.

‡ Adapted from National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Additional Performances Measures. ©2008. National Quality Forum. Please see complete text for details at http://www.qualityforum.org/Publications/2008/10/National_Voluntary_Consensus_Standards_for_Prevention_and_Care_of_Venous_Thromboembolism__Additional_Performance_Measures.aspx. Accessed June 30, 2017.

According to guideline recommendations of the American Academy of Orthopaedic Surgeons (AAOS)†2

When an antithrombotic agent is used to prevent thromboembolism in TKR and THR patients, patients and physicians should discuss the appropriate duration of prophylaxis

Early mobilization should be encouraged for all patients

Resources for Hospital Discharge PlannersGuidelines and Performance Measures to Help Prevent Venous Thromboembolism (VTE) in Knee and Hip Replacement Patients and Improve Care Coordination

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Care Coordination Performance Measures

National Voluntary Consensus Standards for Care Coordination*4

The NQF has endorsed these and other performance measures for effective inpatient discharges to home/self-care or any other site of care

Measure Assessment

Reconciled medication list received by discharged patients (medications include prescription, over-the-counter, and herbal products)

Patients or their caregiver(s) who received a reconciled medication list at discharge including, at a minimum, medications in the following categories:

Medications to be taken by the patient• Continued medications prescribed before inpatient stay that the patient should continue taking

after discharge, including any change in dosage or directions• New medications started during inpatient stay that are to be continued after discharge, and new

medications that the patient should begin taking after discharge• Information provided for all medications should include prescribed dosages, instructions, and

intended duration

Medications not to be taken by the patient• Medications taken by the patient before the inpatient stay that should be discontinued after discharge• Medications that were administered during inpatient stay that caused an allergic reaction or adverse

event and were therefore discontinued

Transition record with specified elements received by discharged patients

Patients or their caregiver(s) who received a transition record (and with whom a review of all included information was documented) at the time of discharge. Record to include all of the following elements:

Inpatient care• Reason for inpatient admission• Major procedures and tests performed, and summary of results• Principal diagnosis at discharge

Postdischarge/patient self-management• Current medication list• Studies pending at discharge (eg, laboratory, radiology)• Patient instructions

Advance care plan• Advance directives or surrogate decision-maker documented, or documented reason for not

providing advance care plan• 24-hour/7-day contact information, including physicians for emergencies related to inpatient stay

and contact information for obtaining results of studies pending at discharge• Plan for follow-up care and primary physician, other healthcare professional, or site designated for

follow-up care

Timely transition of record

Patients for whom a transition record was transmitted to the facility, primary physician, or other healthcare professional designated for follow-up care within 24 hours of discharge

© Janssen Pharmaceuticals, Inc. 2017 July 2017 016600-170630

* Adapted from Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination. ©2010. National Quality Forum. Used with permission. Please see complete text for details at http://www.qualityforum.org/Publications/2010/10/Preferred_Practices_and_Performance_Measures_for_Measuring_and_ Reporting_Care_Coordination.aspx. Accessed June 30, 2017.

References: 1. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schünemann HJ; for the American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive Summary: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):7S-47S. 2. American Academy of Orthopaedic Surgeons. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty evidence-based guideline. http://www.aaos.org/research/guidelines/VTE/VTE_full_guideline.pdf. Accessed June 30, 2017. 3. National Quality Forum. National voluntary consensus standards for prevention and care of venous thromboembolism: additional performance measures. National Quality Forum website. http://www.qualityforum.org/Publications/2008/10/National_Voluntary_Consensus_Standards_for_Prevention_and_Care_of_Venous_Thromboembolism__Additional_Performance_Measures.aspx. Published 2008. Accessed June 30, 2017. 4. National Quality Forum. Preferred practices and performance measures for measuring and reporting care coordination: a consensus report. National Quality Forum website. http://www.qualityforum.org/Publications/2010/10/Preferred_Practices_and_Performance_Measures_for_Measuring_and_Reporting_Care_Coordination.aspx. Published 2010. Accessed June 30, 2017.

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