Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)
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| Measure Information | 2023 Reporting Period | 2024 Reporting Period | 2025 Reporting Period | 2026 Reporting Period |
|---|---|---|---|---|
| Title | Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) | Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) | Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) | Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) |
| CMS eCQM ID | CMS996v3 | CMS996v4 | CMS996v5 | CMS996v6 |
| CBE ID* | 3613e | 3613e | 3613e | 3613e |
| Measure Steward | Centers for Medicare & Medicaid Services (CMS) | Centers for Medicare & Medicaid Services (CMS) | Centers for Medicare & Medicaid Services (CMS) | Centers for Medicare & Medicaid Services (CMS) |
| Description | Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary... intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show more >Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show less |
Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary... intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show more >Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show less |
Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary... intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show more >Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show less |
Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary... intervention (PCI) within 90 minutes of ED arrival, or discharge to an acute care facility within 45 minutes of ED arrival Show more >Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to an acute care facility within 45 minutes of ED arrival Show less |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process | Process |
| Stratification | *See CMS996v3.html |
None |
None |
None |
| Risk Adjustment | *See CMS996v3.html |
None |
None |
None |
| Rationale | *See CMS996v3.html | Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’... Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show more >Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show less |
Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’... Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show more >Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show less |
Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Solhpour & Yusuf, 2013; Fibrinolytic Therapy Trialists’... Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show more >Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Solhpour & Yusuf, 2013; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show less |
| Clinical Recommendation Statement | *See CMS996v3.html | Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:- "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration."- "Primary PCI should be performed in patients with STEMI and...ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."
Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”
Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe HF, irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show more >Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."
Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”
Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe HF, irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show less |
Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:- "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration."- "Primary PCI should be performed in patients with STEMI and...ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."
Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”
Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show more >Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."
Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”
Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show less |
Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that:- "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration."- "Primary PCI should be performed in patients with STEMI and...ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."
Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”
Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show more >Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact."
Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.”
Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show less |
| Improvement Notation |
Improvement noted as an increase in the rate |
Improvement noted as an increase in the rate |
Improvement noted as an increase in the rate |
Increased score indicates improvement |
| Definition | *See CMS996v3.html |
None |
None |
None |
| Guidance |
This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
In order to support the best outcomes for patients and align with other guidelines, PCI device deployment time should be used for calculating the “PCI is performed within 90 minutes of ED arrival” numerator criteria and not the start time of the procedure. This eCQM is an episode-based...measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more >In order to support the best outcomes for patients and align with other guidelines, PCI device deployment time should be used for calculating the “PCI is performed within 90 minutes of ED arrival” numerator criteria and not the start time of the procedure. This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less |
| Initial Population |
All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the measurement period |
All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period |
All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period |
All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions | Patients with the following conditions are excluded from measure denominator: • Expired in the ED• Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplaseWithin 90 days before start of ED encounter:• Ischemic stroke• Significant facial and/or closed head...trauma • Peptic ulcer • Intracranial or intraspinal surgery Within 21 days before end of ED encounter: • Major surgery Within 24 hours before start of ED encounter and during ED encounter: • Suspected aortic dissection • Severe neurologic impairment • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR At the start of ED encounter: • Bleeding or bleeding diathesis (excluding menses) • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Advanced dementia • Pregnancy • Active oral anticoagulant therapy Show more >Patients with the following conditions are excluded from measure denominator: • Expired in the ED • Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Within 90 days before start of ED encounter: • Ischemic stroke • Significant facial and/or closed head trauma • Peptic ulcer • Intracranial or intraspinal surgery Within 21 days before end of ED encounter: • Major surgery Within 24 hours before start of ED encounter and during ED encounter: • Suspected aortic dissection • Severe neurologic impairment • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR At the start of ED encounter: • Bleeding or bleeding diathesis (excluding menses) • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Advanced dementia • Pregnancy • Active oral anticoagulant therapy Show less |
Patients with the following conditions are excluded from measure denominator: During ED encounter:- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplaseAt the start of ED encounter:- Bleeding or bleeding diathesis (excluding menses)- Known malignant...intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Active oral anticoagulant therapy Within 24 hours before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Within 21 days before start of or starts during ED encounter: - Major surgery Within 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Within 90 days before start of ED encounter: - Intracranial or intraspinal surgery Expired in the ED Show more >Patients with the following conditions are excluded from measure denominator: During ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase At the start of ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Active oral anticoagulant therapy Within 24 hours before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Within 21 days before start of or starts during ED encounter: - Major surgery Within 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Within 90 days before start of ED encounter: - Intracranial or intraspinal surgery Expired in the ED Show less |
Patients with the following conditions are excluded from measure denominator: At some point during ED encounter:- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplaseStarts before the start of ED encounter and does not end before ED encounter:- Bleeding...or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter, or most recent dose within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED Show more >Patients with the following conditions are excluded from measure denominator: At some point during ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Starts before the start of ED encounter and does not end before ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter, or most recent dose within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED Show less |
Patients with the following conditions are excluded from measure denominator: At some point during ED encounter:- Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplaseStarts before the start of ED encounter and does not end before ED encounter:- Bleeding...or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter or within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm, Angina pectoris with documented spasm, Aneurysm of heart, Ventricular aneurysm due to and following acute myocardial infarction, Takotsubo cardiomyopathy or syndrome - Severe neurologic impairment - Mechanical circulatory assist device placement or removal, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs within 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED With a discharge disposition of left against medical advice With documentation of hospice services in the 6 months within start of ED encounter, or active hospice status at start of ED encounter Show more >Patients with the following conditions are excluded from measure denominator: At some point during ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Starts before the start of ED encounter and does not end before ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter or within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm, Angina pectoris with documented spasm, Aneurysm of heart, Ventricular aneurysm due to and following acute myocardial infarction, Takotsubo cardiomyopathy or syndrome - Severe neurologic impairment - Mechanical circulatory assist device placement or removal, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs within 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED With a discharge disposition of left against medical advice With documentation of hospice services in the 6 months within start of ED encounter, or active hospice status at start of ED encounter Show less |
| Numerator | Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer;OR- where PCI is performed within 90 minutes of arrival for non-transfer patients;OR- where the patient is transferred within 45 minutes of ED arrival. ... Show more >Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival. Show less |
Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer;OR- where PCI is performed within 90 minutes of arrival for non-transfer patients;OR- where the patient is transferred within 45 minutes of ED arrival ... Show more >Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival Show less |
Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival; OR - where the patient is transferred within 45 minutes of ED arrival |
Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer;OR- where PCI is performed within 90 minutes of arrival;OR- where the patient is discharged to an acute care facility within 45 minutes of ED arrival ... Show more >Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival; OR - where the patient is discharged to an acute care facility within 45 minutes of ED arrival Show less |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
None |
| Denominator Exceptions |
None |
None |
Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours. |
Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours. Emergency department encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival. Emergency department encounters with a...documented reason for not performing a PCI within 90 minutes of ED arrival. Show more >Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours. Emergency department encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of ED arrival. Emergency department encounters with a documented reason for not performing a PCI within 90 minutes of ED arrival. Show less |
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Additional Resources for CMS996v6
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Header
TRN | Measure Section | Source of Change |
|---|---|---|
Updated 'eCQM Identifier (Measure Authoring Tool)' field to 'CMS ID' based on tooling update. | CMS ID | Standards/Technical Update |
Updated the eCQM version number. | eCQM Version Number | Annual Update |
Updated measurement period to reflect exact dates of reporting. | Measurement Period | Standards/Technical Update |
Updated measure developer from Yale New Haven Health Service Corporation/Center for Outcomes Research and Evaluation to Acumen, LLC. | Measure Developer | Annual Update |
Updated Description to reflect inclusion criterion for when a patient is discharged to an acute care facility, aligning with measure intent. | Description | Annual Update |
Updated copyright. | Copyright | Annual Update |
Updated disclaimer. | Disclaimer | Annual Update |
Removed the prefix 'proposed' when referring to the measure, as CMS has finalized the measure for reporting. | Rationale | Annual Update |
Updated Improvement Notation field to read 'Increased score indicates improvement' based on tooling update to promote alignment across measures. | Improvement Notation | Standards/Technical Update |
Added guidance on the use of device deployment time when calculating percutaneous coronary intervention performance in Numerator to align with measure intent. | Guidance | Measure Lead |
Clarified that ischemic stroke, significant facial and/or closed head trauma, and peptic ulcer must occur 'within' 90 days before start of or at start of emergency department encounter to be excluded from the measure Denominator to better align with measure intent. | Denominator Exclusions | Measure Lead |
Added diagnoses of angina pectoris with documented spasm, aneurysm of heart, ventricular aneurysm due to and following acute myocardial infarction, and Takotsubo cardiomyopathy or syndrome that occur 24 hours or less before start of emergency department encounter or during the emergency department encounter to Denominator Exclusion criteria to align with measure intent. | Denominator Exclusions | Measure Lead |
Added a Denominator Exclusion for patients with documentation of hospice services in the six months within the start of the emergency department encounter or active hospice status at the start of the emergency department encounter to allow for consideration of patient/family decision-making in treatment. | Denominator Exclusions | Annual Update |
Added a Denominator Exclusion for patients with a discharge disposition of 'Left Against Medical Advice' to better align with measure intent. | Denominator Exclusions | Measure Lead |
Included 'or removal' in the Denominator Exclusion narrative definition for mechanical circulatory assist device placement to better align with measure intent. | Denominator Exclusions | Measure Lead |
Rephrased the anticoagulant Denominator Exclusion in the header from 'At the start of ED encounter, or most recent dose within 90 days or less of ED encounter' to remove the phrase 'or most recent dose' to better align with measure intent. | Denominator Exclusions | Measure Lead |
Updated the third component of the Numerator description to reflect inclusion criterion for when a patient is discharged to an acute care facility, aligning with measure intent. | Numerator | Measure Lead |
Updated Numerator Exclusions field to read 'None' instead of 'Not Applicable' when no exclusions present to promote alignment across header fields. | Numerator Exclusions | Standards/Technical Update |
Added two Denominator Exceptions to the measure for encounters with a documented reason for not administering fibrinolytic therapy within 30 minutes of emergency department arrival and a documented reason for not performing a percutaneous coronary intervention within 90 minutes of emergency department arrival to align with measure intent. | Denominator Exceptions | Measure Lead |
Updated references and measure header to reflect current evidence and new or updated literature. | Multiple Sections | Measure Lead |
Logic
TRN | Measure Section | Source of Change |
|---|---|---|
Moved the Denominator age restriction of 18 years or older from the Initial Population definition to the 'ED Encounter During MP' definition to improve data processing times. | Initial Population | Annual Update |
Added a Denominator Exclusion for patients with documentation of hospice services in the six months within the start of the emergency department encounter or active hospice status at the start of the emergency department encounter to align with the measure's clinical intent, reflected by the 'ED Encounter with Hospice Services' definition. | Denominator Exclusions | Annual Update |
Added 'Device Placement or Removal' to the Denominator Exclusion definition for intubation or mechanical circulatory assist to better align with measure intent. | Denominator Exclusions | Measure Lead |
Added new definitions, 'Active Use of Anticoagulants' and 'Active Long Term Use of Anticoagulants', for the Denominator Exclusion for active oral anticoagulant therapy to identify both active oral anticoagulant medication at the start of the emergency department encounter as well as active long-term use of anticoagulants to align with measure intent. | Denominator Exclusions | Measure Lead |
Added a Denominator Exclusion for patients with a discharge disposition of 'Left Against Medical Advice,' reflected by the 'ED Encounter With Discharge Disposition As Left Against Medical Advice' definition, to better align with measure intent. | Denominator Exclusions | Measure Lead |
Updated the definition name of the third component of the Numerator definition to 'ED Departure with Discharge To Acute Care Facility Within 45 Minutes of Arrival' to reflect inclusion criteria for when a patient is discharged to an acute care facility, aligning with measure intent. | Numerator | Annual Update |
Added logic for two new Denominator Exceptions, reflected by the 'ED Encounter With A Documented Reason For Not Administering Fibrinolytic Therapy Within 30 Minutes Of ED Arrival' and 'ED Encounter With A Documented Reason For No PCI Performed Within 90 Minutes Of ED Arrival' definitions, to align with measure intent. | Denominator Exceptions | Measure Lead |
Moved the Denominator age restriction of 18 years or older from the Initial Population definition to the 'ED Encounter During MP' definition to improve data processing times. | Definitions | Annual Update |
Added a Denominator Exclusion for patients with a discharge disposition of 'Left Against Medical Advice,' reflected by the 'ED Encounter With Discharge Disposition As Left Against Medical Advice' definition, to better align with measure intent. | Definitions | Measure Lead |
Consolidated three emergency department STEMI diagnosis definitions into a single definition called, 'ED Encounter With STEMI Diagnosis,' to streamline logic. | Definitions | Annual Update |
Updated the version number of the Global Shared Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM'. | Definitions | Annual Update |
Updated the measure's Clinical Quality Language (CQL) file to create a definition for the measure's Denominator Exceptions, resolving a known issue with the measure. | Definitions | Standards/Technical Update |
Updated the CQL library name from 'CMS996-v5-1-000-QDM-5-6.cql' to 'CMS996AptTxforSTEMI-6.3.000.cql' based on recommendation by technical experts. | Definitions | Standards/Technical Update |
Added a Denominator Exclusion for patients with documentation of hospice services in the six months within the start of the emergency department encounter or active hospice status at the start of the emergency department encounter to align with the measure's clinical intent, reflected by the 'ED Encounter with Hospice Services' definition. | Definitions | Annual Update |
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide. | Definitions | Standards/Technical Update |
Added 'Device Placement or Removal' to the Denominator Exclusion definition for intubation or mechanical circulatory assist to better align with measure intent. | Definitions | Measure Lead |
Updated the definition name of the third component of the Numerator definition to 'ED Departure with Discharge To Acute Care Facility Within 45 Minutes of Arrival' to reflect inclusion criteria for when a patient is discharged to an acute care facility, aligning with measure intent. | Definitions | Annual Update |
Added new definitions, 'Active Use of Anticoagulants' and 'Active Long Term Use of Anticoagulants', for the Denominator Exclusion for active oral anticoagulant therapy to identify both active oral anticoagulant medication at the start of the emergency department encounter as well as active long term use of anticoagulants to align with measure intent. | Definitions | Measure Lead |
Added diagnoses of angina pectoris with documented spasm, aneurysm of heart, ventricular aneurysm due to and following acute myocardial infarction, and Takotsubo cardiomyopathy or syndrome that occur 24 hours or less before start of emergency department encounter or during the emergency department encounter to Denominator Exclusion criteria to align with measure intent. | Definitions | Measure Lead |
Added logic for two new Denominator Exceptions, reflected by the 'ED Encounter With A Documented Reason For Not Administering Fibrinolytic Therapy Within 30 Minutes Of ED Arrival' and 'ED Encounter With A Documented Reason For No PCI Performed Within 90 Minutes Of ED Arrival' definitions, to align with measure intent. | Definitions | Measure Lead |
Updated the version number of the Global Shared Library to v9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM'. | Functions | Annual Update |
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
TRN | Measure Section | Source of Change |
|---|---|---|
Replaced value set used for Sex Supplemental Data Element (SDE) ONC Administrative Sex (2.16.840.1.113762.1.4.1) with value set Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121) based on updated standards. | Terminology | Standards/Technical Update |
Added direct reference codes 4 ICD-10-CM codes (I25.3, I20.1, Z79.01, I51.81), 1 LOINC code (45755-6), and 5 SNOMED CT codes (428371000124100, 428361000124107, 441541008, 723858002, 373066001) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set (2.16.840.1.113883.3.3157.4036): Renamed to Active Bleeding or Bleeding Diathesis, Excluding Menses based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Active Bleeding or Bleeding Diathesis, Excluding Menses (2.16.840.1.113883.3.3157.4036): Added 3 ICD-10-CM codes (D65, D63.0, K92.0) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Allergy to thrombolytics (2.16.840.1.113762.1.4.1170.5): Added 2 SNOMED CT codes (1300135006, 1300136007) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Aortic Dissection or Ruptured Aortic Aneurysm (2.16.840.1.113883.3.3157.4028): Added 1 ICD-10-CM code (I71.010) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set (2.16.840.1.113883.3.3157.4048): Renamed to Cardiopulmonary Emergency based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Cardiopulmonary Emergency (2.16.840.1.113883.3.3157.4048): Added 3 ICD-10-CM codes (J96.00, J96.01, J96.02) based on review by technical experts, SMEs, and/or public feedback. Deleted 2 ICD-10-CM codes (I47.20, I47.29) based on review by technical experts, SMEs, and/or public feedback. Deleted 21 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Cerebral Vascular Lesion (2.16.840.1.113883.3.3157.4025): Added 1 ICD-10-CM code (C83.390) based on review by technical experts, SMEs, and/or public feedback. Added 1 SNOMED CT code (307649006) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Closed Head and Facial Trauma (2.16.840.1.113883.3.3157.4026): Added 3 SNOMED CT codes (127295002, 127304009, 127306006) based on terminology update. Added 1 SNOMED CT code (127298000) based on review by technical experts, SMEs, and/or public feedback. Deleted 12 SNOMED CT codes based on terminology update. | Terminology | Measure Lead |
Value set Dementia and Related Intracranial Pathologies (2.16.840.1.113883.3.3157.4043): Added 9 SNOMED CT codes (142001000119106, 230288001, 429998004, 1259485008, 1259501004, 1259586006, 1339031006, 788898005, 833326008) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 ICD-10-CM codes (F01.51, F02.81, F03.91) based on applicability of value set and/or OID. | Terminology | Measure Lead |
Added value set Drug Intervention Not Indicated/Contraindicated (2.16.840.1.113762.1.4.1282.1) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Added value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Value set Endotracheal Intubation (2.16.840.1.113762.1.4.1045.69): Added 3 CPT codes (31500, 94002, 94003) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Added value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Added value set Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Added value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Value set Intracranial or Intraspinal surgery (2.16.840.1.113762.1.4.1170.2): Added 9 SNOMED CT codes (273990004, 1287541008, 1296603004, 1296604005, 1296605006, 1296606007, 1296607003, 1296608008, 1296626006) based on terminology update. Deleted 8 SNOMED CT codes (19994000, 21205002, 243570009, 27968003, 34719005, 51991009, 79272003, 80460006) based on terminology update. | Terminology | Annual Update |
Added value set Left Against Medical Advice (2.16.840.1.113883.3.117.1.7.1.308) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Value set Major Surgical Procedure (2.16.840.1.113883.3.3157.4056): Added 18 ICD-10-PCS codes based on terminology update. Deleted 32 ICD-10-PCS codes based on review by technical experts, SMEs, and/or public feedback. Added 373 SNOMED CT codes based on terminology update. Deleted 265 SNOMED CT codes based on terminology update. | Terminology | Measure Lead |
Value set (2.16.840.1.113883.3.3157.4052): Renamed to Mechanical Circulatory Assist Device based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Mechanical Circulatory Assist Device (2.16.840.1.113883.3.3157.4052): Added 2 SNOMED CT codes (427198005, 426410001) based on review by technical experts, SMEs, and/or public feedback. Added 39 ICD-10-PCS codes based on review by technical experts, SMEs, and/or public feedback. Added 10 CPT codes (33967, 33968, 33971, 33973, 33974, 33977, 33978, 33980, 33992, 33997) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Added value set Patient Refusal (2.16.840.1.113883.3.117.1.7.1.93) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Value set Percutaneous Coronary Intervention (2.16.840.1.113883.3.3157.2000.5): Added 7 SNOMED CT codes (1222571004, 1222673007, 1222674001, 24088005, 410023005, 709981002, 415069007) based on review by technical experts, SMEs, and/or public feedback. Added 2 CPT codes (0913T, 0914T) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Value set Pregnant State (2.16.840.1.113883.3.3157.4055): Added 1 SNOMED CT code (77386006) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |
Added value set Procedure Not Indicated/Contraindicated (2.16.840.1.113762.1.4.1282.2) based on change in measure requirements/measure specification. | Terminology | Measure Lead |
Value set Thrombolytics Adverse Event (2.16.840.1.113762.1.4.1170.6): Added 2 SNOMED CT codes (1300134005, 1300137003) based on review by technical experts, SMEs, and/or public feedback. | Terminology | Measure Lead |