Antithrombotic Therapy By End of Hospital Day 2

Last updated: May 3, 2018

CMS Measure ID: CMS72v5
Version: 5
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 than 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:
Previous Version:
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

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.

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:

AND: Intersection of:

Occurrence A of $EncounterInpatientNonElective

Encounter, Performed: Non-Elective Inpatient Encounter (length of stay < 2 day(s))

AND NOT: Encounter, Performed: Emergency Department Visit <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatientNonElective

The following statement addresses patients who were admitted via the ED:

OR: Encounter, Performed: Emergency Department Visit satisfies all

<= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatientNonElective

< 2 day(s) starts before end of Occurrence A of $EncounterInpatientNonElective.

Notes: Value Set content updated Jan 2017 and Sept 2017, TRNs updated Oct 2017

Specifications

Release Notes

Header

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Added additional guidance language to clarify intent of the measure.

    Measure Section: Guidance

    Source of Change: JIRA (CQM-1512)

  • Removed unit of measurement language from Guidance. HQMF now has a header field, 'measure item count', where the unit of measurement can be identified in a computable fashion.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated initial population header to harmonize across all stroke measures.

    Measure Section: Initial Population

    Source of Change: Measure Lead

Logic

  • Replaced 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis: XXX)' datatype to conform with QDM 4.2 changes and provide more accurate logic.

    Measure Section: Denominator

    Source of Change: QDM Standards

  • Introduced the operator 'Intersection of' to condense logic and reduce complexity.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Replaced 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis: XXX)' datatype to conform with QDM 4.2 changes and provide more accurate logic.

    Measure Section: Initial Population

    Source of Change: QDM Standards

  • Added new attribute 'principal diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic. Removed QDM data element Attribute: 'Ordinality: Principal' using 'Principal SNOMEDCT Value Set (2.16.840.1.113883.3.1.7.1.14.)’ to conform to QDM 4.2. changes and provide more accurate logic.

    Measure Section: QDM Data Elements

    Source of Change: QDM Standards

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 (2.16.840.1.113883.3.117.1.7.1.201): Added 6 RXNORM codes (103863, 1659195, 1659197, 198463, 198464, 198473) and deleted 35 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: JIRA (CQM-1513)

  • Value set Antithrombotic Therapy (2.16.840.1.113883.3.117.1.7.1.201): Added 6 RXNORM codes (103863, 1659195, 1659197, 198463, 198464, 198473) and deleted 35 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: JIRA (CQM-1830)

  • Value set Ischemic Stroke (2.16.840.1.113883.3.117.1.7.1.247): Added 3 SNOMEDCT codes (230701008, 307363008, 426107000) and deleted 5 SNOMEDCT codes (233964008, 288723005, 300920004, 64586002, 71444005). Deleted 18 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Medical Reason (2.16.840.1.113883.3.117.1.7.1.473): Deleted 1 SNOMEDCT code (161590003).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hemorrhagic Stroke (2.16.840.1.113883.3.117.1.7.1.212): Added 1 ICD10CM code (I60.2) and deleted 3 ICD10CM codes (I60.20, I60.21, I60.22).

    Measure Section: QDM Data Elements

    Source of Change: ICD-10 Addendum

  • Value set Ischemic Stroke (2.16.840.1.113883.3.117.1.7.1.247): Added 18 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: ICD-10 Addendum

  • Value set Intravenous or Intra arterial Thrombolytic (tPA) Therapy (2.16.840.1.113762.1.4.1045.21): Added 1 ICD10CM code (Z92.82).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Thrombolytic (t-PA) Therapy (2.16.840.1.113883.3.117.1.7.1.226): Added 2 RXNORM codes (1804799, 1804804) and deleted 1 RXNORM code (308056).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Patient Refusal (2.16.840.1.113883.3.117.1.7.1.93): Added 3 SNOMEDCT codes (183946001, 183956002, 609589008).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Hemorrhagic Stroke (2.16.840.1.113883.3.117.1.7.1.212): Deleted 2 ICD9CM codes (430, 431).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Ischemic Stroke (2.16.840.1.113883.3.117.1.7.1.247): Deleted 12 ICD9CM codes.

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Antithrombotic Therapy (2.16.840.1.113883.3.117.1.7.1.201): Added 24 RXNORM codes and deleted 37 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

  • Value set Antithrombotic ingredient specific (2.16.840.1.113762.1.4.1021.8): Added 1 RXNORM code (5524) and deleted 2 RXNORM codes (235473, 237057).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

External Resources