Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients

Last updated: May 17, 2016

CMS Measure ID: CMS188v4
Version: 4
NQF Number: 0147
Measure Description:

(PN-6) Immunocompetent patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

Population 1 Immunocompetent ICU patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

Population 2 Immunocompetent non-Intensive Care Unit (ICU) patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

Initial Patient Population:

Pneumonia patients 18 years of age and older at the time of admission with a discharge diagnosis of ICD-10-CM Hospital Measures-Principal Diagnosis Code of pneumonia, OR ICD-10-CM Hospital Measures-Principal Diagnosis Code of septicemia or respiratory failure (acute or chronic) and also a secondary ICD-10-CM Other Diagnosis Code of pneumonia. Patient with a LOS <=120 days.

This measure is divided into patients admitted to the intensive care unit (ICU – population 1), and those admitted to non-ICU hospital locations (population 2).

Denominator Statement:

Pneumonia patients 18 years of age and older with An ICD-10-CM Hospital Measures-Principal Diagnosis Code of pneumonia, OR ICD-10-CM Hospital Measures-Principal Diagnosis Code of septicemia or respiratory failure (acute or chronic) and also a secondary ICD-10-CM Other Diagnosis Code of pneumonia.

Denominator Exclusions:
  • Patients with Cystic Fibrosis.
  • Patients with Comfort Measures Only documented on day of or day after arrival.
  • The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for pneumonia, the same condition as covered by the measure. Other clinical trials are not valid reasons for exclusions.
  • Patient with normal chest x-ray/CT Scan
  • Patients received as a transfer from an inpatient or outpatient department of another hospital.
  • Patients received as a transfer from an ambulatory surgery center.
  • Patients who have no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression.
  • Patients with a reason for Alternative Empiric Antibiotic Therapy.
  • Patients transferred/admitted to the ICU within 24 hours after arrival to this hospital, with a beta-lactam allergy (population 1 only).
  • Patients who have duration of stay less than or equal to one day.
  • Pneumonia patients with Another Source of Infection who did not receive an antibiotic regimen recommended for pneumonia, but did receive antibiotics within the first 24 hours of hospitalization.
Numerator Statement:

Pneumonia patients who received an initial antibiotic regimen consistent with current guidelines during the first 24 hours of their hospitalization.

Numerator 1 (in population 1) defines appropriate antibiotics for ICU patients.

Numerator 2 (in population 2) defines appropriate antibiotics for non-ICU patients.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare & Medicaid Services
Domain: Efficiency and Cost Reduction Use of Healthcare Resources
Short Name: PN6
Next Version: Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients
Measure Score: Proportion
Score Type: Process
Improvement Notation:

An increase in rate

Guidance:

General guidance:

The measure criteria indicate scenarios in which the patient is admitted to the hospital directly (to ICU or Non-ICU locations) or the patient is admitted to one of these locations from the Emergency Department (ED).

The calculation is to indicate the timing from arrival at the facility to the occurrence of an event. The arrival, therefore can be determined from the Emergency Department, the Non-ICU location, or the ICU location, whichever is the first location of contact between the patient and the facility.

Exclusion element guidance:

The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for pneumonia, the same condition as covered by the measure. Other clinical trials are not valid reasons for exclusions.

Transfers from another hospital that is not part of the hospital's organization are excluded since care may have been delivered in the other setting. The measure as specified for abstraction allowed determination of other hospitals by hospital billing number.

Transfers within 1 day from those hospitals using the same facility number are not considered transfers for the exclusion section of this measure, those using other facility numbers are considered exclusions.

Respiratory Infection exclusion- the logic indicates that the patient is included if they have a respiratory infection but excluded for any other infection unless the encounter ends <=24 hr after the start.

The exclusion for absolute neutrophil count < 500 may require calculation. The absolute neutrophil count (ANC) = Total WBC x (% Segs + % Bands), OR WBC x ((Segs/100) + (Bands/100)).

Specifications

External Resources