Discharged on Antithrombotic Therapy

Last updated: May 17, 2016

CMS Measure ID: CMS104v4
Version: 4
NQF Number: 0435
Measure Description:

Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge

Initial Patient Population:

Patients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less or equal to 120 days, during the measurement period.

Denominator Statement:

Patients with a principal diagnosis of Ischemic stroke.

Denominator Exclusions:
  • Patients with comfort measures documented.
  • Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.
  • Patients discharged to another hospital
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care
Numerator Statement:

Patients prescribed antithrombotic therapy at hospital discharge.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Patients with a documented reason for not prescribing antithrombotic therapy at discharge.

Measure Steward: The Joint Commission
Domain: Effective Clinical Care
Short Name: Stroke2
Next Version: Discharged on Antithrombotic Therapy
Previous Version: Discharged on Antithrombotic Therapy
Measure Score: Proportion
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

The Non-elective Inpatient Encounter value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the Inpatient encounter value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.

Specifications

Release Notes

Header

  • Copyright updated.
  • eMeasure version number incremented.
  • Rationale updated to reflect FDA approval of novel oral anticoagulant agents (NOACs) for stroke prevention.
  • Removed reference to observation patients from guidance header field, since value set does not include observation encounters.

Logic

  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the 'Intersection of' operator to specify the selection of the data sets common to all individual statements underneath the 'Intersection of'.
  • Introduced variables $EncounterInpatientNonElective and $InterventionComfortMeasures to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed occurrencing and added timing constraint to 'Encounter, Performed: Emergency Department Visit' when this QDM element is used on the right-hand side of a temporal operation, to enforce a constraint that wasn't necessarily achieved through occurrencing alone.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced timing relationship 'during' with 'starts during' where both a start datetime and an end datetime associated with a particular QDM element are not critical to fulfill the measure intent.
  • Replaced timing relationship 'starts before end of' with 'starts before or concurrent with end of' to ensure the inclusion of the end point of the element on the right-hand side of the criterion.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Antithrombotic ingredient specific (OID 2.16.840.1.113762.1.4.1021.8): Deleted 2 RXNORM codes (42463 and 69646).
  • Value set Antithrombotic Therapy (OID 2.16.840.1.113883.3.117.1.7.1.201): Deleted 7 RXNORM codes (1043067, 1192963, 1245473, 1293047, 1294327, 349621, 825174, 204724) and added 6 RXNORM codes (1536670, 1536675, 1536815, 1536833, 1537021, 259081).
  • Value set Discharge to Acute Care Facility (OID 2.16.840.1.113883.3.117.1.7.1.87): Deleted 1 SNOMED code (306699001) and added 2 SNOMED codes (306703003, 434781000124105). Updated value set name from Discharge to Another Hospital to Discharge to Acute Care Facility.

External Resources