Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival

Last updated: February 1, 2017

CMS Measure ID: CMS60v5
Version: 5
NQF Number: None
Measure Description:

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:

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

Denominator Statement:

Includes Initial Population, and patients with an ECG result of acute or evolving MI, who received fibrinolytic therapy 360 minutes starting after the hospital arrival

Denominator Exclusions:

Patients who transferred from an inpatient, outpatient, emergency department or ambulatory surgery center are excluded

Numerator Statement:

AMI patients whose time from hospital arrival to fibrinolysis is 30 minutes or less

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Patients who did not receive fibrinolytic therapy within 30 minutes and have a documented reason. Documented reasons include:

Diagnosis: Cardiopulmonary arrest

Procedure, Performed: Endotracheal Intubation

Procedure, Performed: Aortic balloon pump insertion

Procedure, Performed: Ventricular Assist Device placement

Measure Steward: Centers for Medicare & Medicaid Services (CMS)
Domain: Effective Clinical Care
Short Name: AMI7a
Previous Version: Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

To identify the ECG closest to the hospital arrival, the denominator will identify the most recent ECG performed that starts less than 1 hour prior to the emergency department (ED) or inpatient encounter OR the first ECG performed that starts after the ED or inpatient encounter started.

Specifications

Release Notes

Header

  • Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Updated Denominator Exception criteria to include documented reasons and for consistency across AMI measures.

    Section: Denominator Exceptions

    Source: Measure Lead

  • Consolidated the Denominator Exclusions header language into one statement for conciseness.

    Section: Denominator Exclusions

    Source: Measure Lead

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Measure Lead

  • Updated the header language to add clarity and conciseness by removing duplicated population explanations from the guidance, and only listing these explanations in the denominator exclusions and denominator exception sections.

    Section: Guidance

    Source: Measure Lead

  • Removed ED visit information from the Initial Population section of the header to align with the logic.

    Section: Initial Population

    Source: Measure Lead

  • Updated Endorsed by to 'None.'.

    Section: Endorsed By

    Source: Measure Lead

  • Updated NQF Number to 'Not Applicable.'.

    Section: NQF Number

    Source: Measure Lead

Logic

  • Added occurrencing to Medication, Administered: Fibrinolytic Therapy to meet the intent of the measure in capturing the first occurrence of fibrinolytic therapy during the inpatient encounter.

    Section: Denominator

    Source: JIRA (CQM-1676)

  • Added occurrencing to Medication, Administered: Fibrinolytic Therapy to meet the intent of the measure in capturing the first occurrence of fibrinolytic therapy during the inpatient encounter.

    (see CQM-1676 where this is also addressed).

    Section: Denominator

    Source: Harmonization Review

  • Updated the timing constraint for 'Occurrence A of Encounter, Performed: Emergency Department Visit'  by changing 'starts after start' to 'starts during' to capture an ECG during the ED visit.

    Section: Denominator

    Source: Measure Lead

  • Extended the temporal operators to 'starts before or concurrent with start of' and 'ends before or concurrent with start of' to provide greater flexibility to hospitals in fulfilling the 'Transfer From' statements.

    Section: Denominator Exclusions

    Source: JIRA (CQM-1656)

  • Removed the ‘Union of’ operator from the Initial Population logic as it is no longer needed to meet the measure intent.

    Section: Initial Population

    Source: Measure Lead

  • Removed the Emergency Department (ED) section of logic from the Initial Population as it is not needed to capture the principal diagnosis.

    Section: Initial Population

    Source: Measure Lead

  • Replaced 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis: XXX)' datatype to conform with QDM 4.2 changes and provide more accurate logic.

    Section: Initial Population

    Source: QDM Standards

  • Updated the timing constraint by adding 'or concurrent with' to 'start of Occurrence A' to meet the measure intent.

    Section: Numerator

    Source: JIRA (CQM-1789)

  • Added new attribute 'principal diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic. Removed QDM data element Attribute: 'Ordinality: Principal' using 'Principal SNOMEDCT Value Set (2.16.840.1.113883.3.1.7.1.14.)’ to conform to QDM 4.2. changes and provide more accurate logic.

    Section: QDM Data Elements

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Variables

    Source: QDM Standards

Value Set

  • Value set Acute Myocardial Infarction (AMI) (2.16.840.1.113883.3.666.5.3011): Added 9 SNOMEDCT codes (15712841000119100, 15712881000119105, 15712921000119103, 15712961000119108, 15713041000119103, 15713081000119108, 15713121000119105, 15713161000119100, 15713201000119105) and deleted 1 SNOMEDCT code (194798004).

    Section: None

    Source: None

  • Value set Acute or Evolving MI (2.16.840.1.113883.3.666.5.3022): Added 9 SNOMEDCT codes (15712841000119100, 15712881000119105, 15712921000119103, 15712961000119108, 15713041000119103, 15713081000119108, 15713121000119105, 15713161000119100, 15713201000119105) and deleted 1 SNOMEDCT code (194798004).

    Section: None

    Source: None

  • Value set Ambulatory surgical center (2.16.840.1.113883.3.666.5.687): Added 2 SNOMEDCT codes (10531005, 69362002).

    Section: None

    Source: None

  • Value set Cardiopulmonary arrest (2.16.840.1.113883.3.666.5.748): Added 1 SNOMEDCT code (699748007).

    Section: None

    Source: None

  • Value set Fibrinolytic Therapy (2.16.840.1.113883.3.666.5.736): Deleted 4 RXNORM codes (238721, 346773, 351449, 562122).

    Section: None

    Source: None

  • Value set STEMI Exclusions (2.16.840.1.113762.1.4.1045.36): Added 3 SNOMEDCT codes (233835003, 30277009, 57054005).

    Section: None

    Source: None

  • Value set Ventricular Assist Device placement (2.16.840.1.113883.3.666.5.3015): Deleted 2 SNOMEDCT codes (16965008, 175113001).

    Section: None

    Source: None

External Resources