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Discharged on Antithrombotic Therapy

Compare Versions of: "Discharged on Antithrombotic Therapy"

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Measure Information 2022 Reporting Period 2023 Reporting Period 2024 Reporting Period
Title Discharged on Antithrombotic Therapy Discharged on Antithrombotic Therapy Discharged on Antithrombotic Therapy
CMS eCQM ID CMS104v10 CMS104v11 CMS104v12
Short Name

STK-2

STK-2

STK-2

CBE ID Not Applicable Not Applicable Not Applicable
Description

Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge

Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge

Ischemic stroke patients prescribed or continuing to take antithrombotic therapy at hospital discharge

Definition *See CMS104v10.html *See CMS104v11.html

None

Initial Population

Inpatient hospitalizations 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 the measurement period

Inpatient hospitalizations 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 the measurement period

Inpatient hospitalizations 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 the measurement period

Numerator

Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge

Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge

Inpatient hospitalizations for patients prescribed or continuing to take antithrombotic therapy at hospital discharge

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

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

Denominator Exclusions

Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.

Inpatient hospitalizations for patients discharged to another hospital

Inpatient hospitalizations for patients who left against medical advice

Inpatient hospitalizations for patients who expired

Inpatient hospitalizations for patients discharged to home for hospice care

Inpatient hospitalizations for patients discharged to a health care facility for hospice care

Inpatient hospitalizations for patients with comfort measures documented

* Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.

* Inpatient hospitalizations for patients discharged to another hospital

* Inpatient hospitalizations for patients who left against medical advice

* Inpatient hospitalizations for patients who expired

* Inpatient hospitalizations for patients discharged to home for hospice care

* Inpatient hospitalizations for patients discharged to a health care facility for hospice care

* Inpatient hospitalizations for patients with comfort measures documented

- Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.

- Inpatient hospitalizations for patients discharged to another hospital

- Inpatient hospitalizations for patients who left against medical advice

- Inpatient hospitalizations for patients who expired

- Inpatient hospitalizations for patients discharged to home for hospice care

- Inpatient hospitalizations for patients discharged to a health care facility for hospice care

- Inpatient hospitalizations for patients with comfort measures documented

Denominator Exceptions

Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge.

Inpatient hospitalizations for patients who receive Ticagrelor or Prasugrel as an antithrombotic therapy at discharge.

* Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge

* Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge

- Inpatient hospitalizations for patients with a documented reason for not prescribing antithrombotic therapy at discharge

- Inpatient hospitalizations for patients who receive Prasugrel as an antithrombotic therapy at discharge

Measure Steward The Joint Commission The Joint Commission The Joint Commission
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Improvement noted as an increase in rate

Improvement noted as an increase in rate

Improvement noted as an increase in rate

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 admissions include emergency, urgent and unplanned admissions.

The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.

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 admissions include emergency, urgent and unplanned admissions.

The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.

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 admissions include emergency, urgent and unplanned admissions.

The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.

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.

Rationale *See CMS104v10.html *See CMS104v11.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 continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist.

For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke.

Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or transient ischemic attack (TIA).

Stratification *See CMS104v10.html *See CMS104v11.html

None

Risk Adjustment *See CMS104v10.html *See CMS104v11.html

None

Clinical Recommendation Statement *See CMS104v10.html *See CMS104v11.html

Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist

Next Version No Version Available
Previous Version No Version Available

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Spelled out TIA acronym (transient ischemic attack) for clarity.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Standards/Technical Update

  • 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 for readability and consistency with other measures per external review.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Replaced age calculation from BirthDate with CQL function AgeInYearsAt in the TJCOverall library.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added function 'TruncateTime' to replace retired Global.'ToDate'. Function 'CalendarDayOfOrDayAfter' now uses TJC.'TruncateTime' rather than the retired Global.'ToDate' in TJCOverall library.

    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 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

Last Updated: Mar 04, 2024