Discharged on Antithrombotic Therapy

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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	CMS104v11	CMS104v12	CMS104v13	No Version Available
Previous Version	No Version Available	CMS104v10	CMS104v11	CMS104v12

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Specifications

Additional Resources for CMS104v12

CMS104v12-TRN.xlsx

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