Antithrombotic Therapy By End of Hospital Day 2

Last updated: July 12, 2017

CMS Measure ID: CMS72v4
Version: 4
NQF Number: 0438
Measure Description:

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2.

Initial Patient Population:

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 or equal to 120 days.

Denominator Statement:

Patients with a principal diagnosis of Ischemic stroke.

Denominator Exclusions:
  • Patients who have a duration of stay less than 2 days
  • Patients with comfort measures documented on day or the day after arrival
  • Patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.
Numerator Statement:

Patients who had antithrombotic therapy administered the day of or day after hospital arrival.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Patients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival.

Measure Steward: The Joint Commission
Domain: Effective Clinical Care
Short Name: Stroke5
Next Version: Antithrombotic Therapy By End of Hospital Day 2
Previous Version: Antithrombotic Therapy By End of Hospital Day 2
Measure Score: Proportion
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.

The Non-elective admissions 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.

Specifications

Release Notes

Header

  • Copyright updated.
  • eMeasure version number incremented.
  • Removed reference to observation patients from guidance header field, since value set does not include observation encounters.

Logic

  • Corrected Denominator Exception logic to constrain timing for documentation of patient refusal or medical reasons for not administering Antithrombotic Therapy, improving alignment with chart abstracted measure.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the 'Intersection of' operator to specify the selection of the data sets common to all individual statements underneath the 'Intersection of'.
  • Introduced variables $EncounterInpatientNonElective and $InterventionComfortMeasures to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed occurrencing and added timing constraint to 'Encounter, Performed: Emergency Department Visit' when this QDM element is used on the right-hand side of a temporal operation, to enforce a constraint that wasn't necessarily achieved through occurrencing alone.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • Replaced timing relationship 'during' with 'starts during' where both a start datetime and an end datetime associated with a particular QDM element are not critical to fulfill the measure intent.
  • Replaced timing relationship 'starts before end of' with 'starts before or concurrent with end of' to ensure the inclusion of the end point of the element on the right-hand side of the criterion.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Antithrombotic ingredient specific (OID 2.16.840.1.113762.1.4.1021.8): Deleted 2 RXNORM codes (42463 and 69646).
  • Value set Antithrombotic Therapy (OID 2.16.840.1.113883.3.117.1.7.1.201): Deleted 7 RXNORM codes (1043067, 1192963, 1245473, 1293047, 1294327, 349621, 825174, 204724) and added 6 RXNORM codes (1536670, 1536675, 1536815, 1536833, 1537021, 259081).

External Resources