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Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)

General eCQM Information

CMS Measure ID CMS996v2
Short Name STEMI
NQF Number 03613e
Measure Description

The percentage of emergency department (ED) patients with a diagnosis of ST-segment elevation myocardial infarction (STEMI) who received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival. The measure is intended for use at the facility level in a CMS accountability program, through which it may be publicly reported.

Initial Population ED patients 18 years of age and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) who should have received appropriate treatment for STEMI.
Denominator Statement

Equals Initial Population

Denominator Exclusions

Patients with the following conditions active at the time of the ED encounter are excluded from measure denominator:

  • Mortality in the ED
  • Bleeding or bleeding diathesis (excluding menses)
  • Intracranial or intraspinal surgery
  • Ischemic stroke
  • Known malignant intracranial neoplasm (primary or metastatic)
  • Known structural cerebral vascular lesion (e.g., AVM)
  • Significant facial and/or closed head trauma
  • Suspected aortic dissection
  • Peptic ulcer
  • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR
  • Allergic reaction to streptokinase/anistreplase
  • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation
  • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device
  • Oral anticoagulant therapy
  • Advanced dementia
  • Pregnancy
  • Internal bleeding
  • Major surgery
  • Severe neurologic impairment (e.g., based on Glasgow coma scale or as indicated by the patient receiving therapeutic hypothermia in the ED)
Numerator Statement

ED STEMI patients whose time from ED arrival to fibrinolysis is 30 minutes or fewer; OR non-transfer ED STEMI patients who received PCI within 90 minutes of arrival; OR, ED STEMI patients who were transferred within 45 minutes of ED arrival.

Numerator Exclusions

None

Denominator Exceptions

None

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Improvement noted as an increase in the rate

Guidance

This measure calculates the percentage of ED patients with a STEMI diagnosis who received appropriate treatment (PCI, fibrinolytic therapy, or transfer). The measure is calculated as follows:

  1. System check E/M Code; if E/M code represents care provided in the ED, proceed
  2. Calculate Patient Age (Outpatient Encounter Date - Birthdate)
  3. Patient Age >= 18, proceed
  4. System check ICD-10-CM Principal Diagnosis Code;
  5. Apply denominator exclusions to remove patients excluded from the measure denominator; all remaining cases are equal to the denominator count, proceed
  6. System check Fibrinolytic Administration; if “Yes,” proceed; if no
  7. System check PCI Received; if “Yes,” proceed; if no
  8. System check Transferred for PCI; if “Yes,” proceed;
  9. System check Fibrinolytic Administration Date and Time; if a Non-Unable to Determine (UTD) value, proceed
  10. System check Arrival Time; if a Non-UTD value, proceed
  11. System calculates Time to Fibrinolysis (Fibrinolytic Administration Time minus Arrival Time)
  12. System check Time to Fibrinolysis; if >= 0 min and <= 30 min, include in the numerator. If > 30 min and <=360 min or missing, proceed
  13. System check PCI Received, check PCI Date; if a Non-UTD value, proceed
  14. System check PCI Procedure Time; if a Non-UTD value, proceed
  15. System check Arrival Time; if a Non-UTD value, proceed
  16. System calculate Time to PCI (PCI Procedure Time minus Arrival Time)
  17. System check Time to PCI; if >=0 min and <=90 min, record as the numerator; if >90 minutes and <=360 min or missing, proceed
  18. System check Transferred for PCI, check Transfer for PCI Date; if a Non-UTD value, proceed
  19. System check Transfer for PCI Time; if a Non-UTD value, proceed
  20. System check Arrival Time; if a Non-UTD value, proceed
  21. System calculate Time to Transfer for PCI; if >=0 min and <=45 min, include in the numerator.
  22. Measure = aggregated numerator counts / aggregated denominator counts [The value should be recorded as a percentage]
Meaningful Measure Management of Chronic Conditions
Last Updated: Jul 20, 2021