Crnary Artery Disease (CAD): Beta Blcker Therapy fr CAD Patients with Prir Mycardial Infarctin (MI) (NQF 0070) EMeasure Name Crnary Artery Disease EMeasure Id Pending (CAD): Beta Blcker Therapy fr CAD Patients with Prir Mycardial Infarctin (MI) Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December 31, 20xx Measure Steward American Medical Assciatin Physician Cnsrtium fr Perfrmance Imprvement Endrsed by Descriptin Measure scring Measure type Ratinale Clinical Recmmendatin Statement Natinal Quality Frum Percentage f patients aged 18 years and lder with a diagnsis f CAD and prir MI wh were prescribed beta blcker therapy. Prprtin Prcess In the absence f cntraindicatins, beta blcker therapy has been shwn t reduce the risk f a recurrent MI and decrease mrtality fr thse patients with a prir MI. Chrnic Stable Angina: Class I Beta blckers as initial therapy in the absence f cntraindicatins in patients with prir MI. Class I Beta blckers as initial therapy in the absence f cntraindicatins in patients withut prir MI (ACC/AHA/ACP ASIM). Unstable Angina and Nn ST Segment Elevatin Mycardial Infarctin: Class I Drugs required in the hspital t cntrl ischemia shuld be cntinued after hspital discharge in patients wh d nt underg crnary revascularizatin, patients with unsuccessful revascularizatin, r patients with recurrent symptms after revascularizatin. Upward r dwnward titratin f the dses may be required. Class I Beta blckers in the absence f cntraindicatins (ACC/AHA). Acute Mycardial Infarctin: Class I All but lw risk patients withut a clear cntraindicatin t ß adrenceptr blcker therapy. Treatment shuld begin within a few days f the event (if nt initiated acutely) and cntinue indefinitely. Class IIa Lw risk patients withut a clear cntraindicatin t ß adrenceptr blcker therapy. Survivrs f nn ST elevatin MI. Class IIb Patients with mderate r severe LV failure r ther relative cntraindicatins t ß adrenceptr blcker therapy, prvided they can be mnitred clsely (ACC/AHA). References Althugh n study has determined if lng term ß adrenceptr blcker therapy shuld be administered t survivrs f MI wh subsequently have satisfactrily undergne revascularizatin, there is n reasn t believe that these agents act differently in crnary patients wh have undergne revascularizatin (ACC/AHA).
Definitins Table f Cntents Ppulatin criteria Data criteria (QDS Data Elements) Summary calculatin Please refer t the spreadsheet fr this measure fr detail regarding data criteria and cde lists. Ppulatin criteria Initial Patient Ppulatin = Denminatr = Numeratr = Exclusins = Patient characteristic: birth date (age) >= 18 years; OR: Diagnsis active: crnary artery disease n MI ; OR: Prcedure perfrmed: cardiac surgery ; >= 2 cunt(s) f: OR: Encunter: encunter nursing facility ; OR: Encunter: encunter utpatient ; OR: >= 1 cunt(s) f Encunter: encunter inpatient discharge ; All patients in the initial patient ppulatin; Diagnsis reslved: mycardial infarctin ; OR: Medicatin rder: beta blcker therapy ; OR: Medicatin active: beta blcker therapy ; OR: Diagnsis active: arrhythmia ; OR: Diagnsis active: hyptensin ; OR: Diagnsis active: asthma ; OR: Diagnsis active: bradycardia ; OR: Diagnsis active: atresia and stensis f arta ; OR: Diagnsis active: atriventricular blck ; AND NOT: OR: Diagnsis active: cardiac pacer in situ ; OR: Device applied: cardiac pacer ; OR: Prcedure perfrmed: cardiac mnitring ; OR: Medicatin adverse event: beta blcker therapy ;
OR: Medicatin allergy: beta blcker therapy ; OR: Medicatin intlerance: beta blcker therapy ; OR: Medicatin nt dne: medical reasn ; OR: Medicatin nt dne: patient reasn ; OR: Medicatin nt dne: system reasn ; OR: >1 cnsecutive cunt(s) f Physical exam finding: heart rate, < 50 bpm; Data criteria (QDS Data Elements) Initial Patient Ppulatin = Denminatr = Numeratr = Exclusins = "Patient characteristic: birth date using birth date cde list befre the beginning f the measurement perid ; Diagnsis active: crnary artery disease n MI using crnary artery disease n MI cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Prcedure perfrmed: cardiac surgery using cardiac surgery cde list gruping befre r simultaneusly t the Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Encunter: encunter nursing facility using encunter nursing facility cde list during the measurement perid ; Encunter: encunter utpatient using encunter utpatient cde list during the measurement perid ; Encunter: encunter inpatient discharge using encunter inpatient discharge cde list during the measurement perid ; All patients in the initial patient ppulatin; Diagnsis reslved: mycardial infarctin using mycardial infarctin cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin rder: beta blcker therapy using beta blcker therapy cde list during the measurement perid ; Medicatin active: beta blcker therapy using beta blcker therapy cde list during the measurement perid ; Diagnsis active: arrhythmia using arrhythmia cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: hyptensin using hyptensin cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: asthma using asthma cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ;
Diagnsis active: bradycardia using bradycardia cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: atresia and stensis f arta using atresia and stensis f arta cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: atriventricular blck using atriventricular blck cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Diagnsis active: cardiac pacer in situ using cardiac pacer in situ cde list gruping befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Device applied: cardiac pacer device using cardiac pacer device cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Prcedure perfrmed: cardiac mnitring using cardiac mnitring cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin adverse event: beta blcker therapy using beta blcker therapy cde list befre r simultaneusly t En cunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin allergy: beta blcker therapy using beta blcker therapy cde list befre r simultaneusly t En cunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin intlerance: beta blcker therapy using beta blcker therapy cde list befre r simultaneusly t En cunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Medicatin nt dne: medical reasn using medical reasn cde list fr Medicatin rder: beta blcker therapy OR Medicatin active: beta blcker therapy ; Medicatin nt dne: patient reasn using patient reasn cde list fr Medicatin rder: beta blcker therapy OR Medicatin active: beta blcker therapy ; Medicatin nt dne: system reasn using system reasn cde list fr Medicatin rder: beta blcker therapy OR Medicatin active: beta blcker therapy ; Physical exam finding: heart rate using heart rate cde list befre r simultaneusly t Encunter: encunter utpatient OR Encunter: encunter nursing facility OR Encunter: encunter inpatient discharge ; Summary Calculatin Calculatin is generic t all measures: Calculate the final denminatr by adding all that meet denminatr criteria. Subtract frm the final denminatr all that d nt meet numeratr criteria yet als meet exclusin criteria. Nte sme measures d nt have exclusin criteria. The perfrmance calculatin is the number meeting numeratr criteria divided by the final denminatr. Fr measures with multiple patient ppulatins, repeat this prcess fr each patient ppulatin and reprt each result separately.
Fr measures with multiple numeratrs, calculate each numeratr separately within each ppulatin using the paired exclusin. Measure set CLINICAL QUALITY MEASURE SET 2011 2012