3.68
new VTE cases per 100 resident-years
Reported across 181 nursing homes in 19 U.S. states.
Primary Care
Suspected DVT? Scan in your office.
Primary care has evidence for both sides of the problem. CMS1173 defines a VTE diagnosis made more than 24 hours after a primary-care visit where symptoms were documented as delayed, and at two U.S. health systems most qualifying cases met that definition.
Primary care also has direct evidence that trained physicians can perform proximal compression ultrasound. In Italy’s multicenter PRACTICUS study, general practitioners reached 95.8% diagnostic accuracy, with excellent agreement with blinded vascular-ultrasound experts (κ = 0.86).
2023 · DOVE beta test
72.6%Site 1
77.1%Site 2
CMS put a number on the delay.
At two U.S. health systems, nearly three in four qualifying VTE cases met the DOVE definition of delayed diagnosis. Across the 50 largest primary-care sites at Site 1, rates ranged from 46.15% to 100%.
2025 · DOVE follow-up
79-82%after 24 h
70-71%after 72 h
The delay remained common.
Across 3,525 patients at two U.S. health systems, delayed diagnosis was the norm. At the larger system, 30-day mortality was 8.33% with delayed diagnosis versus 2.52% with timely diagnosis, a risk ratio of 3.31.
The next measurement phase
$2 million
AHRQ is expanding the work.
Grant R01 HS030221 is extending DOVE across urban and rural primary and urgent care, identifying causes of delayed and missed VTE diagnoses, and measuring their costs.
PRACTICUS · Italy
95.8%
Primary-care physicians performed the scan.
After two months of formal training (12 hours didactic, 30 hands-on, 8 image review), 18 general practitioners performed proximal compression ultrasound in 1,107 consecutive outpatients: 90.0% sensitivity, 97.1% specificity, and κ = 0.86 versus blinded vascular experts.
PRACTICUS evaluated trained physicians performing bilateral proximal compression ultrasound. It does not establish autonomous diagnosis or replace comprehensive venous duplex when clinically indicated.