Antithrombotic Therapy By End of Hospital Day 2
Compare Versions of: "Antithrombotic Therapy By End of Hospital Day 2"
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| Measure Information | 2022 Reporting Period | 2023 Reporting Period | 2024 Reporting Period | 2025 Reporting Period |
|---|---|---|---|---|
| Title | Antithrombotic Therapy By End of Hospital Day 2 | Antithrombotic Therapy By End of Hospital Day 2 | Antithrombotic Therapy By End of Hospital Day 2 | Antithrombotic Therapy by End of Hospital Day 2 |
| CMS eCQM ID | CMS72v10 | CMS72v11 | CMS72v12 | CMS72v13 |
| Short Name |
STK-5 |
STK-5 |
STK-5 |
STK-5 |
| CBE ID* | Not Applicable | Not Applicable | Not Applicable | Not Applicable |
| Measure Steward | The Joint Commission | The Joint Commission | The Joint Commission | The Joint Commission |
| Description |
Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2 |
Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2 |
Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2 |
Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2 |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process | Process |
| Stratification | *See CMS72v10.html | *See CMS72v11.html |
None |
None |
| Risk Adjustment | *See CMS72v10.html | *See CMS72v11.html |
None |
None |
| Rationale | *See CMS72v10.html | *See CMS72v11.html |
The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist. Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy. Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA. |
The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks (TIA) continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity if no contraindications exist. Aspirin is the recommended antithrombotic medication for early antithrombotic therapy and most frequently administered unless contraindicated. Anticoagulants at doses to prevent venous thromboembolism (VTE) are insufficient. Subcutaneous Lovenox (enoxaparin) and unfractionated heparin (UFH) SQ at lower dosages used for VTE prophylaxis (i.e., enoxaparin SQ 40 mg once daily; enoxaparin SQ 30 mg Q12 hours; UFH 5,000 units or less two or three times daily) are not sufficient for early antithrombotic therapy. Anticoagulants at doses to prevent VTE are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA. |
| Clinical Recommendation Statement | *See CMS72v10.html | *See CMS72v11.html |
Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist |
Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity if no contraindications exist |
| Improvement Notation |
Improvement noted as an increase in rate |
Improvement noted as an increase in rate |
Improvement noted as an increase in rate |
Improvement noted as an increase in rate |
| Definition | *See CMS72v10.html | *See CMS72v11.html |
None |
None |
| Guidance |
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 Inpatient Encounters include emergency, urgent, and unplanned admissions. NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e. rectal or intravenous). In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM. |
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 Inpatient Encounters include emergency, urgent, and unplanned admissions. NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e. rectal or intravenous). In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
The "Nonelective 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 Inpatient Encounters include emergency, urgent, and unplanned admissions. NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous). In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including ED visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
The "Nonelective 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 Inpatient Encounters include emergency, urgent, and unplanned admissions. NPO (Nothing by mouth) is not a valid reason for not administering antithrombotic therapy by end of hospital day 2 as another route of administration can be used (i.e., rectal or intravenous). In the denominator exclusions, the intent is to only exclude patients with a total length of stay of <2 days, including emergency department (ED) visit (if there is one). For the eCQM we model both of the scenarios of admission via the ED as well as direct admits. This statement addresses direct admits. The denominator population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
Inpatient hospitalization for 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 than or equal to 120 days that ends during measurement period |
Inpatient hospitalization for 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 than or equal to 120 days that ends during measurement period |
Inpatient hospitalization for 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 than or equal to 120 days that ends during measurement period |
Inpatient hospitalizations (non-elective admissions) for patients age 18 and older, discharged from inpatient care with a principal diagnosis of ischemic stroke, ending during the measurement period |
| Denominator |
Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke |
Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke |
Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke |
Equals Initial Population |
| Denominator Exclusions |
Inpatient hospitalizations for patients who have a duration of stay less than 2 days. Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival. Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization. |
* Inpatient hospitalizations for patients who have a duration of stay less than 2 days * Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival * Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization |
- Inpatient hospitalizations for patients who have a duration of stay less than 2 days - Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival - Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization |
- Inpatient hospitalization for patients who have a duration of stay less than 2 days - Inpatient hospitalization for patients with comfort measures documented day of or the day after arrival - Inpatient hospitalization for patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization |
| Numerator |
Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival |
Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival |
Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival |
Inpatient hospitalization for patients who had antithrombotic therapy administered the day of or day after hospital arrival |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
Not Applicable |
| Denominator Exceptions |
Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival. Inpatient hospitalization for patients who receive Ticagrelor or Prasugrel as an antithrombotic therapy the day of or day after hospital arrival. Inpatient hospitalization for patients with an INR greater than 3.5. |
* Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival * Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival * Inpatient hospitalization for patients with an INR greater than 3.5 |
- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival - Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival - Inpatient hospitalization for patients with an INR greater than 3.5 |
- Inpatient hospitalization for patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival. - Inpatient hospitalization for patients who receive Prasugrel as an antithrombotic therapy the day of or day after hospital arrival. - Inpatient hospitalization for patients with an international normalized ratio (INR) greater than 3.5. |
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Additional Resources for CMS72v11
Header
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Added clarifying text noting VTE prophylaxis does not suffice as antithrombotic therapy.
Measure Section: Rationale
Source of Change: Measure Lead
Updated guidance to indicate patients in Acute Hospital Care at Home programs are included in the denominator population.
Measure Section: Guidance
Source of Change: Measure Lead
Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update
Updated denominator exceptions statement to remove ticagrelor as an applicable exception, per the new FDA-approved indication for its use in ischemic stroke. Ticagrelor is now included in the value sets for numerator compliance.
Measure Section: Denominator Exceptions
Source of Change: Measure Lead
Added bullets and made minor grammar edits for readability and consistency with other measures per external review.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Logic
Updated definition name to distinguish it from library definition and to match its purpose.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Replaced age calculation from BirthDate with CQL function AgeInYearsAt in the TJCOverall library.
Measure Section: Definitions
Source of Change: Measure Lead
Replaced Global.ToDate() with TJC.TruncateTime() in the function of TJC.'CalendarDayOfOrDayAfter'.
Measure Section: Functions
Source of Change: Measure Lead
Updated the version number of the TJC Overall Library to v6.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the timing precision in definitions using the function TJC.'CalendarDayOfOrDayAfter' from datetime to date by adding 'day of', 'date from', and/or function 'ToDateInterval' to align with the measure intent.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update
Value set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
Value set Pharmacological Contraindications For Antithrombotic Therapy (2.16.840.1.113762.1.4.1110.52): Deleted 2 RxNorm codes (1116635, 1666332) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Antithrombotic Therapy (2.16.840.1.113762.1.4.1110.62): Added 2 RxNorm codes (1116635, 1666332) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Added 4 RxNorm codes (2588062, 198466, 243670, 252857) based on terminology update.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Medical Reason (2.16.840.1.113883.3.117.1.7.1.473): Deleted 1 SNOMED CT code (397745006) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead