Last updated: May 17, 2016
|CMS Measure ID:||CMS60v3|
Acute myocardial infarction (AMI) patients with ST-segment elevation on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less.
|Initial Patient Population:||
All hospital discharges for acute myocardial infarction (AMI) with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission with ST-elevation on electrocardiogram (ECG) who received fibrinolytic therapy.
Patients age 18 and older with an ICD-9-CM Principal Diagnosis Code for AMI AND ST-segment elevation on the last ECG performed prior to hospital arrival or the first ECG performed after hospital arrival; AND Fibrinolytic therapy received within 6 hours after hospital arrival AND Fibrinolytic therapy is primary reperfusion therapy.
AMI patients whose time from hospital arrival to fibrinolysis is 30 minutes or less.
Patients who did not receive fibrinolytic therapy within 30 minutes and had a documented reason for delay in fibrinolytic therapy.
|Measure Steward:||Oklahoma Foundation for Medical Quality|
|Domain:||Effective Clinical Care|
|Next Version:||Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival|
Higher score indicates better quality
Because of QDM limitations to identify the closest event to another event, the denominator will identify the last ECG performed within 1 hour prior to hospital arrival OR the first ECG performed after hospital arrival.
Denominator element guidance:
For the denominator data element Diagnostic Study, Result: Hospital Measures-ECG Impression, EHR implementations will need to develop mechanisms to capture ECG findings to support denominator criteria for this measure. The measure specification indicates allowable findings. The source of the ECG results should be a physician/APN/PA (rather than the ECG machine's computerized results).
Numerator element guidance:
This measure expects fibrinolytic therapy within 30 minutes of hospital arrival. Those patients receiving fibrinolysis greater than 30 minutes after arrival may be excluded from the denominator only if there is a documented reason for a delay or documented occurrence of intubation, cardiopulmonary arrest or mechanical circulatory assist device placement within the first 30 minutes after arrival. Patients receiving fibrinolysis greater than 30 minutes after arrival and with no reason provided are not compliant with the numerator criteria and will remain in the denominator.
Exclusion element guidance:
The intent for the exclusion for patients who are clinical trial participants was to be limited to patients participating in a clinical trial for acute myocardial infarction (AMI), ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (non-STEMI), heart attack, or acute coronary syndrome (ACS), the same conditions as covered by the measure. However, the value set specifying clinical trial participation is not limited to a specific type of trial.
Transfers from another hospital are excluded since care may have been delivered in the other setting. Transfers from those hospitals are considered exclusions regardless of whether the receiving hospital has the same or different hospital unique identifier as the transferring hospital.
Exception element guidance:
Medical or patient reasons for not performing a procedure or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision.
Denominator, Numerator, Exclusion and Exception element guidance:
The criteria indicate scenarios in which the patient is admitted to the hospital directly or the patient is admitted from the Emergency Department (ED). The calculation is to indicate the timing from arrival at the facility to the occurrence of an event.