2026 MIPS Measure #514: Diagnostic Delay of Venous Thromboembolism in Primary Care

Percentage of episodes for patients 18 years of age and older with documented Venous Thromboembolism (VTE) symptoms in the primary care setting and who had a diagnosis of VTE that occurs > 24 hours and within 30 days following the index primary care visit where symptoms for the VTE were first present.

Venous Thromboembolism or VTE disease consists of pulmonary embolism and deep vein thrombosis. VTE is a deadly disease and more timely treatment can improve patient outcomes (Beckman, et al. 2010). Evidence from the literature as well as data from our site support this linkage. According to the Centers for Disease Control and Prevention (CDC) up to 900,000 people in USA are affected by VTE which results is more than 100,000 deaths each year (CDC, 2024). Pulmonary embolism (PE) is an independent predictor of reduced survival for up to 3 months after onset and up to 45% of patients with a PE die within 3 months (Heit JA, 2006). VTE is also associated with increased morbidity, increased health care costs and decreased quality of life (Rathbun S, 2009 and Rabinovich N, 2017). Long term morbidity includes post-thrombotic syndrome (PTS) and pulmonary hypertension (Kahn SR, 2004). PTS is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients (Rabinovich N, 2017). PTS is associated with chronic venous insufficiency and associated signs and symptoms can impose significant morbidity and have a negative impact on quality of life. VTE can also have an impact on subsequent pregnancies, estrogen use, surgery, life insurance and travel (Tran HA, 2019). The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. The evidence that PE increases morbidity and mortality is robust and DVT is strongly associated with PE.
Traditionally, there has not been a systematic way to measure the incidence of delayed diagnosis of VTE and therefore the estimates in the literature are based on manual record review and vary widely. The DOVE eCQM is an automated tool that quantifies delayed diagnosis that builds a foundation for automated VTE risk assessment and prompt treatment to prevent delayed diagnosis and adverse outcomes.
The American Society of Hematology published VTE diagnosis guidelines to provide an evidence-based strategy to efficiently evaluate patients (Lim, 2018, updated 2022). The goal of these guidelines is to improve diagnostic accuracy by assisting providers with evaluating patients with suspected VTE while reducing unnecessary and more invasive testing (Lim, et al. 2018). While routine use of guidelines in primary care would likely reduce the number of missed or delayed VTE diagnoses, integration into practice is challenging. VTE symptoms are nonspecific and often present as symptoms consistent with an underlying chronic illness. Strategies such as clinical decision support and measurement of diagnostic performance are needed to assist primary care providers with adopting VTE diagnosis guidelines and routinely using them in clinical practice. Currently, there is no way to measure VTE diagnostic performance. Metrics are needed to quantify suboptimal VTE diagnostic performance, improved early recognition of VTE symptoms, and ultimately reducing unfavorable VTE outcomes.
Measuring and reporting delayed VTE diagnosis rates will inform healthcare providers and facilities about opportunities to improve care, strengthen incentives for quality improvement, and ultimately improve the quality of care received by patients.