Discharged on Antithrombotic Therapy

Last updated: May 3, 2018

CMS Measure ID: CMS104v5
Version: 5
NQF Number: 0435
Measure Description:

Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge

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 with comfort measures documented
  • Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.
  • Patients discharged to another hospital
  • Patients who left against medical advice
  • Patients who expired
  • Patients discharged to home for hospice care
  • Patients discharged to a health care facility for hospice care
Numerator Statement:

Patients prescribed antithrombotic therapy at hospital discharge

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Patients with a documented reason for not prescribing antithrombotic therapy at discharge

Measure Steward: The Joint Commission
Domain: Effective Clinical Care
Short Name: Stroke2
Next Version:
Previous Version:
Improvement Notation:

Improvement noted as an increase in rate

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 admissions include emergency, urgent and unplanned admissions.

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

  • 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

  • Update references to align with chart-abstracted measures.

    Measure Section: Reference

    Source of Change: Chart Abstracted Measures

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 Variables

    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 Variables

    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 Variables

    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 Variables

    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 Variables

    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 Variables

    Source of Change: ICD-10 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 Variables

    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 Variables

    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 Variables

    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 Variables

    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 Variables

    Source of Change: 4Q 2017 Addendum

External Resources