PIO N EERS IN Q UA LITY: EX PERT TO EX PERT CMS53/ AMI 8a: Pr imar y PCI R e c e ive d Within 90 Minute s of Hospital Ar r ival Bo b Dic ke rso n, RRT , MHSA, T e llig e n L ynn Pe rrine , MSN, RN, L a nta na Co nsulting Gro up Ang e la F la na g a n, MSN, RN, CPHI MS, L a nta na Co nsulting Gro up
Disc ussion T opic s • L o g ic spe c ific a tio ns fo r AMI 8a • F re q ue ntly Aske d Que stio ns fo r AMI 8a • Cha ng e s to me a sure spe c ific a tio ns fo r 2017 re po rting 2
Bac kgr ound • Pe rc uta ne o us Co ro na ry I nte rve ntio n (PCI ) is a pro c e dure tha t o pe ns b lo c ke d b lo o d ve sse ls a nd pre ve nts furthe r he a rt musc le da ma g e fo llo wing a he a rt a tta c k. • Must pe rfo rm PCI q uic kly to b e e ffe c tive . • I nitia lly pa rt o f AMI Me a sure Se t • E -spe c ifie d in 2013 3
Me asur e De sc r iption Ac ute myoc ar dial infar c tion (AMI) patie nts with ST -se gme nt e le vation on the e le c tr oc ar diogr am (E CG) c lose st to ar r ival time r e c e iving pr imar y PCI during the hospital stay with a time fr om hospital ar r ival to PCI of 90 minute s or le ss. 4
R ationale • T he e a rly use o f prima ry a ng io pla sty in pa tie nts with ST -se g me nt myo c a rdia l infa rc tio n (ST E MI ) re sults in a sig nific a nt re duc tio n in mo rta lity a nd mo rb idity. T he e a rlie r PCI is pro vide d, the mo re e ffe c tive it is (Bro die , 1998 a nd De L uc a , 2004). • Na tio na l g uide line s re c o mme nd the pro mpt initia tio n o f PCI in pa tie nts pre se nting with ST -e le va tio n myo c a rdia l infa rc tio n (O'Ga ra , 2013; a nd L e vine , 2011). 5
Var iable s L ogic state me nts r e use d thr oughout a me asur e : • Denoted with a “$” • De fine d in the Da ta Crite ria (QDM Va ria b le s) se c tio n 6
AMI 8a Var iable s $EncounterInpatient = • "Encounter, Performed: Encounter Inpatient" satisfies all - (length of stay <= 120 day(s)) - ends during "Measurement Period" $AnotherHospitalOrHealthcareFacility = • Union of: - "Transfer From: Ambulatory Surgical Center" - "Transfer From: Transfer From Outpatient" - "Transfer From: Transfer From Emergency Department (ED) Locations" - "Transfer From: Transfer From Inpatient " 7
AMI 8a Var iable s, c ontinue d $ReasonForNoFibrinolyticTherapy = • Union of: - "Diagnosis, Active: Cardiopulmonary arrest" - "Procedure, Performed: Endotracheal Intubation" - "Procedure, Performed: Aortic balloon pump insertion" - "Procedure, Performed: Ventricular Assist Device placement" Note : $Re asonF or NoF ibr inolytic T he r apy has be e n update d to $R e asonF or NoPCI in ve r sion 5. 8
Initial Population R e quire me nts • Pa tie nts must b e a t le a st 18 ye a rs o ld. • E nc o unte r must inc lude princ ipa l dia g no sis o f AMI . • Dia g no sis must b e re c o rde d during inpa tie nt e nc o unte r o r E D visit. • E D visit is o nly c o nside re d if it o c c urs within o ne ho ur o f inpa tie nt a dmissio n. 9
Initial Population • AND: Age > = 18 year(s) at: Occurrence A of $EncounterInpatient • AND: • OR: "Diagnosis, Active: Acute Myocardial Infarction (AMI) (ordinality: Principal)" starts during Occurrence A of $EncounterInpatient • OR: "Diagnosis, Active: Acute Myocardial Infarction (AMI) (ordinality: Principal)" starts during ("Encounter, Performed: Emergency Department Visit" <= 1 hour(s) and ends before or concurrent with start of Occurrence A of $EncounterInpatient) 10
De nominator R e fine s c ase s by asse ssing AMI patie nts ide ntifie d in IP with: • ST -e le va tio n o n E CG • Re c e ive d prima ry PCI • F ib rino lytic the ra py no t initia te d Denominator = • AND: Initial Population 11
– E De nominator CG AND: o OR: AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient AND: Union of: • Most recent: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG)" <= 1 hour(s) starts before start of "Occurrence A of Encounter, Performed: Emergency Department Visit" • First: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG)" starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit“ o OR: AND NOT: "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient AND: Union of: • Most recent: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG)" <= 1 hour(s) starts before start of Occurrence A of $EncounterInpatient • First: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG)" starts after start of Occurrence A of $EncounterInpatient 12
– diagnosis De nominator AND: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: Acute or Evolving MI)" AND NOT: "Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: STEMI Exclusions)" 13
De nominator - PCI AND: o OR: AND: First: "Occurrence A of Procedure, Performed: PCI (ordinality: Primary Procedure)" <= 1440 minute(s) starts after start of Occurrence A of $EncounterInpatient AND NOT: "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient AND NOT: "Occurrence A of Procedure, Performed: PCI" starts after start of • "Occurrence A of Medication, Administered: Fibrinolytic Therapy" during Occurrence A of $EncounterInpatient o OR: AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient AND: First: "Occurrence A of Procedure, Performed: PCI (ordinality: Primary Procedure)" <= 1440 minute(s) starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit" AND NOT: "Occurrence A of Procedure, Performed: PCI" starts after start of • "Occurrence A of Medication, Administered: Fibrinolytic Therapy" starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit 14
De nominator E xc lusions Pa tie nts re c e ive d a s a tra nsfe r fro m: • I npa tie nt o r Outpa tie nt De pa rtme nt • E me rg e nc y De pa rtme nt • Amb ula to ry Surg ic a l Ce nte r Denominator Exclusions = • OR: $AnotherHospitalOrHealthcareFacility <= 1 day(s) starts before start of o "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient • OR: o AND: $AnotherHospitalOrHealthcareFacility <= 1 day(s) starts before start of Occurrence A of $EncounterInpatient o AND NOT: "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient 15
Nume r ator Asse sse s AMI pa tie nts who se time fro m ho spita l a rriva l to prima ry PCI is 90 minute s o r le ss. Numerator = • AND: o OR: AND: "Occurrence A of Procedure, Performed: PCI (ordinality: Primary Procedure)" <= 90 minute(s) starts after start of Occurrence A of $EncounterInpatient AND NOT: "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient o OR: "Encounter, Performed: Emergency Department Visit" satisfies all <= 90 minute(s) starts before start of "Procedure, Performed: PCI" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient 16
De nominator E xc e ptions Pa tie nts with a spe c ifie d me dic a l dia g no sis o r pro c e dure pe rfo rme d: • Ca rdio pulmo na ry a rre st • E ndo tra c he a l intub a tio n • Ao rtic b a llo o n pump inse rtio n • Ve ntric ula r a ssist de vic e pla c e me nt 17
De nominator E xc e ptions E xpr e ssion Denominator Exceptions = • OR: $ReasonForNoFibrinolyticTherapy <= 90 minute(s) starts after start of o "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient • OR: o AND: $ReasonForNoFibrinolyticTherapy <= 90 minute(s) starts after start of Occurrence A of $EncounterInpatient o AND NOT: "Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient 18
QDM Data E le me nts “Procedure, Performed: Aortic balloon pump insertion" using "Aortic balloon pump insertion SNOMEDCT Value Set (2.16.840.1.113883.3.666.5.1151)” Cate gory: Pro c e dure ype : Pro c e dure , Pe rfo rme d Data T Value Se t: Ao rtic b a llo o n pump inse rtio n Code Syste m: SNOME D Code s: 175113001, 399052009, 399175004, 399217008, 432375005, 442807006, 83676006 19
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