Key Metric # 1

Performance Tracking (selecting and reporting metrics)

Key metric # 1: prevalence of appropriate VTE prophylaxis

After reading Analyze Care Delivery, the diagram below should be familiar. Though we used it earlier to understand care delivery, we use it now to measure care delivery.

Specifically, we’ll now look at this diagram to select metrics – meaningful and measurable steps the team can use to track performance over time. In most instances the most telling metric is the prevalence of appropriate prophylaxis. Not only does it have the most causal relationship to the main clinical endpoint, hospital-acquired VTE, but it is also a sensitive indicator of how well the various care

Figure 3-1: Outcomes Chain for Preventing Hospital-Acquired VTE

Figure 3-1: Outcomes Chain for Hospital-Acquired VTE. Whether a patient develops a preventable hospital-acquired DVT or PE depends heavily on recent, appropriate VTE prophylaxis. While one key metric to track is the intermediate outcome “appropriate VTE prophylaxis,” the more proximal steps in the care delivery pathway are where care re-design will likely occur, e.g. your VTE protocol. The other key metric to track is the prevalence of hospital-acquired DVT or PE.

Using the prevalence of appropriate VTE prophylaxis as one of the team’s 2 key metrics also offers something that can be measured regularly and reliably. Set up daily, weekly, or monthly data collection for this metric (see Section 3-3). This data flow offers a reliable way to track performance of the changed care delivery system. What makes the clinical endpoint of HA-VTE unsuitable as a lone metric for performance tracking is that events are too infrequent and often sub-clinical or delayed in onset for timely, useful feedback.

It should now be clear how the VTE protocol serves not just as the main ingredient for the improvement intervention, but also for the measurement system that can track performance.