**4.2 Quality measures**

Over the past 5 years, quality measures have been proposed and put into clinical application to monitor compliance with best practice guidelines in VTE prophylaxis. The Surgical Care Improvement Project (SCIP) was created in 2006 with reduction of VTE being one of its four primary focus areas. The Center for Medicare and Medicaid Services (CMS) has declared postoperative VTE as a "never event." As such, the CMS will no longer reimburse the hospital the costs associated with these complications. Other agencies and consumer groups have also declared VTE as a preventable complication.

Several important improvements have already occurred as a result of these outcome measures. Surgeons and administrators have collectively established hospital-wide or hospital system-wide prophylaxis protocols. They have also worked to establish training and education programs to deliver the best practice guidelines to all the staff involved in patient care. Several limitations still exist however. The AAOS and the ACCP guidelines should be modified to establish a consensus. Unmet needs and improvement in the safety profiles hopefully will be fulfilled by newer agents in clinical development (Huo, 2011a).
