New Study Reveals Troubling Trends in VTE Tracking

In a first-of-its-kind study, Rishi Rattan, M.D., assistant professor of clinical surgery in the University of Miami Miller School of Medicine’s DeWitt Daughtry Family Department of Surgery, along with a team of six faculty members and students, examined the risk for patients of developing venous thromboembolism (VTE) following trauma.

Dr. Rattan was first author of the study, “Hidden burden of venous thromboembolism after trauma: A national analysis,” which was published in the November issue of the Journal of Trauma and Acute Care Surgery.

“Venous thromboembolism, or VTE, is a blood clot that starts in the vein, and is typically triggered by surgery, cancer, immobilization, or hospitalization,” Dr. Rattan said. “It is the third leading vascular diagnosis after heart attack and stroke, affecting roughly 600,000 Americans each year.”

Because VTE cases are one of the most common preventable causes of hospital mortality, they are closely tracked to determine the quality of care hospitals provide. The government, quality agencies, insurers, researchers, and other interested parties use these numbers to rank hospitals, determine payments, and make recommendations for the institutions to deliver the best possible care.

One of the problems uncovered by the study, however, is that the tracking of VTEs is inaccurate.

“We found that approximately one in three patients who develop blood clots after a hospitalization for trauma are missed by current tracking efforts, because they get readmitted to a different hospital,” Dr. Rattan said. “We need to better understand who is being missed so that we can target preventive programming toward them.”

Dr. Rattan said that enhanced tracking of VTEs would allow researchers to design better studies to get more reliable information, improve outcomes, increase accuracy of quality assessment metrics, and actually refine benchmarking.

“There are no prior national studies measuring readmissions to different hospitals with VTE after trauma,” Dr. Rattan said. “Thus, before our study, the true national burden in trauma patients readmitted with VTE was unknown and can provide a benchmark to improve quality of care.”

Another problem revealed by the study, according to Dr. Rattan, is that for-profit hospitals were found to “hide” more of their readmissions at different hospitals.

“Without this information,” Dr. Rattan said, “their readmissions rates look falsely better when compared to other non-profit, public, or safety net hospitals and so they get unfairly set as the benchmark.”

Readmission to different hospitals also has financial ramifications, the study showed. The total yearly cost of readmissions with VTE was close to $257 million, and more than $90 million of that was a result of readmission to a different hospital. Much of that added cost is borne by taxpayers, according to Dr. Rattan.

For this study, Dr. Rattan was joined by Arjuna Dharmaraja, a 4th-year medical student; Sarah A. Eidelson, M.D., general surgery resident; Enrique Ginzburg, M.D., professor of clinical surgery; Nicholas Namias, M.D., MBA, professor of surgery and chief of the Division of Trauma Surgery and Critical Care; Joshua Parreco, M.D., trauma fellow; D. Dante Yeh, M.D., associate professor of surgery; and Tanya L. Zakrison, M.D., MHSc, MPH, associate professor of clinical surgery.

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