Statin Prescribed at Discharge

Last updated: May 4, 2017

CMS Measure ID: CMS30v5
Version: 5
NQF Number: 0639
Measure Description:

Acute myocardial infarction (AMI) patients who are prescribed a statin medication at hospital discharge.

Initial Patient Population:

Patients age 18 and older at the time of hospital admission with a principal diagnosis of Acute Myocardial Infarction (AMI) with hospital stays <= 120 days during the measurement year.

Measure Population:

Not applicable

Measure Observations:

Not applicable

Denominator Statement:

All patients in the Initial Population

Denominator Exclusions:
  • Patients with Comfort Measures documented
  • 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:

AMI patients who are prescribed a statin medication at hospital discharge.

Numerator Exclusions:

None

Denominator Exceptions:
  • Patients with LDL of less than 100 mg/dL within the first 24 hours after hospital arrival or 30 days prior to hospital arrival.
  • Or patients with a documented Reason for Not Prescribing Statin Medication at Discharge. This includes patients with a statin allergy, the administration of statin medications are on HOLD, or a medical or patient reason for not prescribing a statin.
Measure Steward: Centers for Medicare & Medicaid Services
Domain: Effective Clinical Care
Short Name: AMI10
Next Version: Statin Prescribed at Discharge
Previous Version: Statin Prescribed at Discharge
Measure Score: Proportion
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

Exclusion element guidance:

Medical or patient reasons for not performing a test 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.

Specifications

Release Notes

Header

  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • Removed 'Clinical Trial Participant' in the Denominator Exclusions due to the inability to capture clinical trials that are specific to the measure.
  • Removed the word 'Only' from 'Patients with Measures Comfort Only documented' in the Denominator Exclusions of the header to align with the name of the value set.
  • Updated Denominator, Denominator Exclusions and Denominator Exceptions to be consistent across hospital measures and align with logic.
  • Updated Guidance in the header to align with the measure logic.
  • Updated Initial Population header statement to be consistent across hospital measures and align with logic.

Logic

  • Added logic to include a diagnosis of active AMI that starts during the ED visit to capture the start of the diagnosis.
  • Changed Comfort Measures timing, logic, and added a variable, $InterventionComfortMeasures, to align with measure intent.
  • Changed data type of 'Result' or 'Finding' to 'Performed'.
  • Changed timing for allergy and medication order not done: Medical Reason and Patient Refusal to align with measure intent. Removed Occurrencing when denoting a specific event was not necessary.
  • Consolidated Medication Administered not done: Medication Hold logic.
  • Introduced $InterventionComfortMeasures to consolidate and simplify 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 variable $EncounterInpatient to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed 'Clinical Trial Participant' logic due to the inability to capture clinical trials that are specific to the measure.
  • Replaced 'ends before start' with 'ends before or concurrent with start of' to align across measures (when appropriate for measure intent).
  • 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 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • Revised Logic permits the removal of AND NOT clauses in the Denominator exception which reduces the complexity of the measure.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Acute Myocardial Infarction (AMI) (OID 2.16.840.1.113883.3.666.5.3011): Added 29 SNOMED codes. Updated name from Hospital Measures - AMI to Acute Myocardial Infarction (AMI).
  • Value set Clinical Trial Participant (OID 2.16.840.1.113883.3.526.2.643): Removed value set from this measure.
  • 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.
  • Value set LDL-c Test (OID 2.16.840.1.113883.3.117.1.7.1.799): Replaced by 2.16.840.1.113883.3.117.1.7.1.215 (LOINC) to harmonize EH measures.
  • Value set Medication Hold (OID 2.16.840.1.113883.3.666.5.1145): Updated value set name from Hospital Measures - Hold to Medication Hold.
  • Value set Statin Allergen (OID 2.16.840.1.113883.3.117.1.7.1.42): Deleted 1 RXNORM code (404775).
  • Value set Statin ingredient specific (OID 2.16.840.1.113762.1.4.1021.7): Deleted 3 RXNORM codes (17767, 341248, 593411).

External Resources