Measure Information Form

Transcription

1 **NQF-ENDORSED VOLUNTRY CONSENSUS STNDRDS FOR HOSPITL CRE** Measure Set: cute Myocardial Infarction (MI) Set Measure ID#: Measure Information Form Performance Measure Name: PCI Received Within 120 Minutes of Hospital rrival Description: cute myocardial infarction (MI) patients receiving percutaneous coronary intervention (PCI) during the hospital stay with a time from hospital arrival to PCI of 120 minutes or less Rationale: The early use of primary angioplasty in patients with acute myocardial infarction who present with ST-segment elevation or L results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is (rodie, 1998). National guidelines recommend the prompt initiation of PCI in patients presenting with ST elevation myocardial infarction (Ryan, 1999). Despite these recommendations, few older patients hospitalized with MI receive primary angioplasty within a timely manner (Jencks, 2000). Type of Measure: Process Improvement Noted as: n increase in the rate Numerator Statement: MI patients whose time from hospital arrival to PCI is 120 minutes or less Included Populations: Not pplicable Excluded Populations: None Data Elements: rrival Date rrival Time First PCI Date First PCI Time Release Notes: Measure Information Form Version

2 Denominator Statement: MI patients with ST elevation or L on ECG who received PCI Included Populations: Discharges with: n ICD-9-CM Principal Diagnosis Code for MI as defined in ppendix, Table 1.1 ND PCI (ICD-9-CM Principal and Other Procedure Codes for PCI as defined in ppendix, Table 1.2) ND ST segment elevation or L on the ECG performed closest to hospital arrival ND PCI performed within 24 hours after hospital arrival Excluded Populations: Patients less than 18 years of age Patients received in transfer from another acute care hospital, including another emergency department Patients administered thrombolytic agents Data Elements: dmission Date dmission Source rrival Date rrival Time irthdate First PCI Date First PCI Time ICD-9-CM Other Procedure Codes ICD-9-CM Principal Diagnosis Code ICD-9-CM Principal Procedure Code Initial ECG Interpretation Thrombolytic dministration Transfer From nother ED Risk djustment: No Data Collection pproach: Retrospective data sources for required data elements include administrative data and medical records. Data ccuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency. -2

3 Measure nalysis Suggestions: The measure rate for PCI received within 120 minutes of hospital arrival should be analyzed in conjunction with the median time to PCI measure (MI-8). These measures, used together, will assist in understanding the number of MI patients that are receiving PCI within 120 minutes of hospital arrival, and will identify the hospital s median time to PCI and potential opportunities for improvement to increase the rate of patients receiving PCI in 120 minutes or less. Sampling: Yes, for additional information see the Sampling Section. Data Reported as: ggregate rate generated from count data reported as a proportion Selected References: ntman EM, nbe DT, rmstrong PW, ates ER, Green L, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas G, Mullany CJ, Ornato JP, Pearle DL, Sloan M, Smith SC Jr. CC/H guidelines for the management of patients with ST-elevation myocardial infarction: a report of the merican College of Cardiology/merican Heart ssociation Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With cute Myocardial Infarction) vailable at rodie R, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy D, Weintraub R, Kelly T. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J m Coll Cardiol. 1998; Jencks SJ, Cuerdon T, urwen DR, Fleming, Houck PM, Kussmaul E, Nilasena DS, Ordin DL, rday DR. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. JM. 2000;284: Ryan TJ, ntman EM, rooks, NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel, Russell RO, Smith EE III, Weaver WD update: CC/H guidelines for the management of patients with acute myocardial infarction: a report of the merican College of Cardiology/merican Heart ssociation Task Force on Practice Guidelines (Committee on Management of cute Myocardial Infarction). J m Coll Cardiol 1999;34: Ryan TJ, nderson JL, ntman EM, raniff, rooks NH, Califf RM, Hillis LD, Hiratzka L F, Rapaport E, Riegel J, Russell RO, Smith EE III, Weaver WD. CC/H guidelines for the management of patients with acute myocardial infarction: a report of the merican College of Cardiology/merican Heart ssociation Task Force on Practice Guidelines (Committee on Management of cute Myocardial Infarction). J m Coll Cardiol 1996;28:

4 : PCI Received Within 120 Minutes of Hospital rrival Numerator: MI patients whose time from hospital arrival to PCI is 120 minutes or less. Denominator: MI patients with ST elevation or L on ECG who received PCI. Start Variable Key: Patient ge Time to PCI ICD-9-CM Principal Diagnosis Code Not on Table 1.1 On Table 1.1 dmission Date irthdate Patient ge (in years) = dmission Date minus irthdate Note: The algorithm to calculate age must use the month and day portion of admission date and birthdate to yield the most accurate age. age is < 0 days (negative value) Patient ge age is > or = 0 days and < 18 years (Initial population, common to all measures in the MI set) age is > or = 18 years H -4

5 H dmission Source = 4 or = 1, 2, 3, 5, 6, 7, 8 or 9 Transfer From nother ED = Y = N Initial ECG = N Interpretation = Y Thrombolytic = Y dministration = N ll Invalid ICD-9-CM Principal Procedure Code and/or ICD-9-CM Other Procedure Codes Missing or Not on Table 1.2 Note: Look for Invalid ICD-9-CM Other Procedure Codes prior to determining if the code is in the population. On Table 1.2 I -5

6 I Missing/ Invalid First PCI Time Missing/Invalid First PCI Date Missing/Invalid rrival Date Missing or Invalid Measure Population Data Z rrival Time Time to PCI= First PCI Date and First PCI Time minus rrival Date and Time in minutes Time to PCI < 0 minutes or > 1440 minutes Not In Measure Population > or = 0 minutes and < or = 1440 minutes Time to PCI > 120 minutes Measure Population DIn Z < or = 120 minutes Z E In Numerator Population Stop -6