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Discharged on Antithrombotic Therapy

Compare Versions of: "Discharged on Antithrombotic Therapy"

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Table Options
Measure Information 2022 Reporting Period 2023 Reporting Period 2024 Reporting Period 2025 Reporting Period
Title Discharged on Antithrombotic Therapy Discharged on Antithrombotic Therapy Discharged on Antithrombotic Therapy Discharged on Antithrombotic Therapy
CMS eCQM ID CMS104v10 CMS104v11 CMS104v12 CMS104v13
Short Name

STK-2

STK-2

STK-2

STK-2

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 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

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

Measure Scoring Proportion measure Proportion measure Proportion measure Proportion measure
Measure Type Process Process Process Process
Stratification *See CMS104v10.html *See CMS104v11.html

None

None

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

None

None

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).

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 if 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).

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

Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke 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 CMS104v10.html *See CMS104v11.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 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.

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.

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

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 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

- 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 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

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

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Not Applicable

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

- 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

Next Version No Version Available
Previous Version No Version Available

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Rationale

    Source of Change: Annual Update

  • Renamed value set from 'Non-Elective Inpatient Encounter' to 'Nonelective Inpatient Encounter' to remove special characters.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Changed upper case 'Ischemic stroke' to 'ischemic stroke'.

    Measure Section: Denominator

    Source of Change: Standards/Technical Update

  • Replaced asterisks with bullets to align with style guide.

    Measure Section: Denominator Exclusions

    Source of Change: Standards/Technical Update

  • Replaced asterisks with bullets to align with style guide.

    Measure Section: Denominator Exceptions

    Source of Change: Standards/Technical Update

Logic

  • Removed definition 'Antithrombotic 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 'Encounter with No Antithrombotic At Discharge' to 'Encounter with Documented Reason for No Antithrombotic At Discharge' consistent with recommendation from clinical experts.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • 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

  • Updated the version number of the TJC Overall Library to v7.1.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Updated the version number of the TJC Overall Library to v7.1.000.

    Measure Section: Functions

    Source of Change: Annual 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 Antithrombotic Therapy for Ischemic Stroke (2.16.840.1.113762.1.4.1110.62): Added 9 RxNorm codes (2267026, 2360605, 2590616, 2590620, 2590623, 2590627, 2590631, 2590635, 2618839) based on terminology update. Deleted 1 RxNorm code (308417) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113762.1.4.1110.62): Renamed to Antithrombotic Therapy for Ischemic Stroke based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • 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

Last Updated: Jun 03, 2024