Venous Thromboembolism: Detection and Surveillance Bias

Mila Ju, MD Resident, Division of Vascular Surgery Northwestern University 676 N. Saint Clair St., Ste 650 Chicago, IL  60611MedicalResearch.com Interview with:
Mila Ju, MD
Resident, Division of Vascular Surgery
Northwestern University
676 N. Saint Clair St., Ste 650
Chicago, IL  60611


MedicalResearch.com: What are the main findings of the study?

Dr. Ju: By using combined data from Hospital Compare, American Hospital Association, and Medicare claims databases, we found that better hospital venous thromboembolism (VTE) prophylaxis adherence rates were weakly associated with worse risk-adjusted VTE event rates. Moreover, hospitals with higher intensity of detecting VTE with imaging studies (such as venous duplex, chest computer tomography, etc.) had more VTE events (13.5 in highest VTE imaging quartile vs 5.0 in lowest VTE imaging quartile) per 1000 discharges. Our study suggests that VTE rates might be influenced by surveillance bias and not reflecting the true quality of care provided by the hospitals.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Ju: Hospital structural characteristics that were associated with better VTE prophylaxis adherence rates were unexpectedly associated with worse VTE event rates. However, this paradoxical finding was consistent with our surveillance bias hypothesis.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Ju: Current hospital performance measures on VTE are deficient as they are subjective to surveillance bias.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Ju: Publicaly reported process and outcome measures should reflect the care provided by the hospitals. Further research should focus on developing VTE quality of care measures.

Citation:

Evaluation of Surveillance Bias and the Validity of the Venous Thromboembolism Quality Measure

Bilimoria KY, Chung J, Ju MH, et al. Evaluation of Surveillance Bias and the Validity of the Venous Thromboembolism Quality Measure. JAMA. 2013;310(14):1482-1489. doi:10.1001/jama.2013.280048.