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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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Specifications
Attachment Size
CMS72v13.html 93.63 KB
CMS72v13.zip 85.82 KB
CMS72v13-TRN.xlsx 22.52 KB
eCQM Jira Issue Tracker
*Note there may be more tickets in the eCQM Tracker - ONC Project Tracking System (Jira) for this measure. Only tickets tagged with their associated CMS measure ID appear.

Header

  • Updated the eCQM version number.

    Measure Section:

    eCQM Version Number

    Source of Change:

    Annual Update

  • Changed all references from NQF to CBE to identify the consensus-based entity role.

    Measure Section:

    CBE Number

    Source of Change:

    Annual Update

  • Updated copyright.

    Measure Section:

    Copyright

    Source of Change:

    Annual Update

  • Removed length of stay requirement from narrative to align with global common library update.

    Measure Section:

    Initial Population

    Source of Change:

    Measure Lead

  • Removed narrative text referring to hemorrhagic stroke. Measure refers only to the ischemic stroke population.

    Measure Section:

    Initial Population

    Source of Change:

    Measure Lead

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

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

  • Updated references and measure header to reflect current evidence and new or updated literature.

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

Logic

  • Removed the time function, 'TJC.TruncateTime,' from the TJCOverall Library and updated the calendar day function 'TJC.CalendarDayOfOrDayAfter' to align with the measure intent.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Updated the version number of the TJCOverall Library to v8.0.000 and the library name from 'TJCOverall' to 'TJCOverallQDM.'

    Measure Section:

    Definitions

    Source of Change:

    Annual Update

  • Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.

    Measure Section:

    Definitions

    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:

    Definitions

    Source of Change:

    Standards/Technical Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'

    Measure Section:

    Definitions

    Source of Change:

    Annual Update

  • Updated the version number of the TJCOverall Library to v8.0.000 and the library name from 'TJCOverall' to 'TJCOverallQDM.'

    Measure Section:

    Functions

    Source of Change:

    Annual Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'

    Measure Section:

    Functions

    Source of Change:

    Annual Update

  • Removed the time function, 'TJC.TruncateTime,' from the TJCOverall Library and updated the calendar day function 'TJC.CalendarDayOfOrDayAfter' to align with the measure intent.

    Measure Section:

    Functions

    Source of Change:

    Measure Lead

  • Updated 'Ischemic Stroke Encounter' to include new definition 'Non Elective Encounter with Age.'

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

  • Removed definition 'All Stroke Encounter' due to the removal of hemorrhagic stroke from the initial population.

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

  • Removed 120 day length of stay criteria to align with global common library update.

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

  • Created a single definition 'Non Elective Encounter with Age,' consolidating definitions 'Non Elective Inpatient Encounter' and 'Encounter with Principal Diagnosis and Age.'

    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 Antithrombotic Therapy for Ischemic Stroke (2.16.840.1.113762.1.4.1110.62): Added 13 RxNorm codes based on terminology update. Deleted 1 RxNorm code (1804738) based on terminology update. Deleted 2 RxNorm codes (854228, 854235) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Removed value set Hemorrhagic Stroke (2.16.840.1.113883.3.117.1.7.1.212) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Value set (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.

    Measure Section:

    Terminology

    Source of Change:

    Annual Update

Last Updated: Jun 03, 2024