Anticoagulation Therapy for Atrial Fibrillation or Flutter
Compare Versions of: "Anticoagulation Therapy for Atrial Fibrillation or Flutter"
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| Measure Information | 2022 Reporting Period | 2023 Reporting Period | 2024 Reporting Period |
|---|---|---|---|
| Title | Anticoagulation Therapy for Atrial Fibrillation or Flutter | Anticoagulation Therapy for Atrial Fibrillation or Flutter | Anticoagulation Therapy for Atrial Fibrillation or Flutter |
| CMS eCQM ID | CMS71v11 | CMS71v12 | CMS71v13 |
| Short Name |
STK-3 |
STK-3 |
STK-3 |
| CBE ID | Not Applicable | Not Applicable | Not Applicable |
| Measure Steward | The Joint Commission | The Joint Commission | The Joint Commission |
| Description |
Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge |
Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge |
Ischemic stroke patients with atrial fibrillation/flutter who are prescribed or continuing to take anticoagulation therapy at hospital discharge |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process measure | Process measure | Process measure |
| Stratification | *See CMS71v11.html | *See CMS71v12.html |
None |
| Risk Adjustment | *See CMS71v11.html | *See CMS71v12.html |
None |
| Rationale | *See CMS71v11.html | *See CMS71v12.html |
Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from one and a half percent for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke. |
| Clinical Recommendation Statement | *See CMS71v11.html | *See CMS71v12.html |
The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke |
| Improvement Notation |
Improvement noted as an increase in rate |
Improvement noted as an increase in rate |
Improvement noted as an increase in rate |
| Definition | *See CMS71v11.html | *See CMS71v12.html |
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. 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 Inpatient Encounters 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 Inpatient Encounters 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. |
| 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 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 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 measurement period |
| Denominator |
Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke, and a history of atrial ablation, or current or history of atrial fibrillation/flutter |
Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke, and a history of atrial ablation, or current or history of atrial fibrillation/flutter |
Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke, and a history of atrial ablation, or current or history of atrial fibrillation/flutter |
| 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 |
| Numerator |
Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge |
Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge |
Inpatient hospitalizations for patients prescribed or continuing to take anticoagulation therapy at hospital discharge |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
Not Applicable |
| Denominator Exceptions |
Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge |
Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge |
Inpatient hospitalizations for patients with a documented reason for not prescribing anticoagulation therapy at discharge |
| Next Version | No Version Available | ||
| Previous Version | No Version Available |
Header
Updated grammar, wording, and/or formatting to improve readability and consistency.
Measure Section: Description
Source of Change: Annual Update
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Replaced asterisks with bullets to align with style guide.
Measure Section: Denominator Exclusions
Source of Change: Standards/Technical Update
Logic
Added value set 'History of Atrial Ablation' to provide additional approaches for identifying history of atrial ablation.
Measure Section: Denominator
Source of Change: Measure Lead
Removed definition 'Anticoagulant Therapy at Discharge' and replaced it with inline reference to QDM datatype 'Medication, Discharge' to improve readability.
Measure Section: Numerator
Source of Change: Measure Lead
Renamed definition from 'Reason for Not Giving Anticoagulant at Discharge' to 'Documented Reason for Not Giving Anticoagulant at Discharge' based on recommendation from clinical experts.
Measure Section: Denominator Exceptions
Source of Change: Measure Lead
Updated the version number of the TJC Overall Library to v7.1.000.
Measure Section: Definitions
Source of Change: Annual Update
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Definitions
Source of Change: Standards/Technical Update
Combined two definitions, 'Encounter with a history of Atrial Fibrillation or Flutter' and 'Encounter with Current Diagnosis Code of Atrial Fibrillation or Flutter', and renamed to 'Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Flutter' align with logic intent.
Measure Section: Definitions
Source of Change: Measure Lead
Added Global functions EarliestOf, Earliest and HasStart in new history of atrial ablation logic.
Measure Section: Functions
Source of Change: Measure Lead
Updated the version number of the TJC Overall Library to v7.1.000.
Measure Section: Functions
Source of Change: Annual Update
Added QDM datatypes 'Assessment, Performed' and 'Diagnosis' for new value set 'History of Atrial Ablation' to provide additional approaches for identifying patients with a history of atrial ablation to reduce burden.
Measure Section: Multiple Sections
Source of Change: Measure Lead
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 Anticoagulant Therapy (2.16.840.1.113883.3.117.1.7.1.200): Added 7 RxNorm codes (2590616, 2590620, 2590623, 2590627, 2590631, 2590635, 2618839) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Atrial Fibrillation or Flutter (2.16.840.1.113883.3.117.1.7.1.202): Added 2 SNOMED CT codes (312442005, 428076002) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Added value set History of Atrial Ablation (2.16.840.1.113762.1.4.1110.76) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.117.1.7.1.473): Renamed to Medical Reason For Not Providing Treatment based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Patient Refusal (2.16.840.1.113883.3.117.1.7.1.93): Added 2 SNOMED CT codes (1162745003, 895451009) based on terminology update. Deleted 5 SNOMED CT codes (183944003, 413312003, 183947005, 371138003, 609589008) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead