Antithrombotic Therapy By End of Hospital Day 2

Last updated: October 25, 2017

CMS Measure ID: CMS72v6
Version: 6
NQF Number: None
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 that ends during measurement period

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
Short Name: Stroke5
Previous Version: Antithrombotic Therapy By End of Hospital Day 2
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.

NPO 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:

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.

Addendum Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Replaced NQF Number '0438' with 'Not Applicable' as the measure is no longer endorsed.

    Measure Section: NQF Number

    Source of Change: Measure Lead

  • Replaced 'National Quality Forum' with 'None' as the measure is no longer endorsed.

    Measure Section: Endorsed By

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Added Guidance to better align with measure intent.

    Measure Section: Guidance

    Source of Change: JIRA (CQM-2481)

  • Added 'that ends during the measurement period' to the Initial Population narrative statement to better align with measure logic.

    Measure Section: Initial Population

    Source of Change: JIRA (CQM-2520)

Logic

  • Added 'Occurrence A of' to $EncounterInpatientNonElective to correct error of omission.

    Measure Section: Denominator Exclusions

    Source of Change: JIRA (CQM-2266)

  • Replaced 'Antithrombotic ingredient specific' value set with 'Antithrombotic Therapy' semantic clinical drug value set to ease implementation burden.

    Measure Section: Denominator Exceptions

    Source of Change: JIRA (CQM-1835)

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 23 RXNORM codes and deleted 34 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: Chart-Abstracted Measures

  • 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: Measure Lead

  • 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: Measure Lead

  • 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: Measure Lead

  • 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: Measure Lead

  • Replaced Antithrombotic ingredient specific value set (2.16.840.1.113762.1.4.1021.8) with Antithrombotic Therapy value set (2.16.840.1.113883.3.117.1.7.1.201).

    Measure Section: QDM Data Elements

    Source of Change: JIRA (CQM-1835)

  • 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: 2018 Addendum

  • Value set Antithrombotic Therapy (2.16.840.1.113883.3.117.1.7.1.201): Added 1 RXNORM code (1658717) and deleted 3 RXNORM codes (205251, 308287, 646434).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources