Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet

Last updated: May 14, 2018

CMS Measure ID: CMS164v7
Version: 7
NQF Number: 0068
Measure Description:

Percentage of patients 18 years of age and older who were diagnosed with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antiplatelet during the measurement period

Initial Patient Population:

Patients 18 years of age and older with a visit during the measurement period who had an AMI, CABG, or PCI during the 12 months prior to the measurement year or who had a diagnosis of IVD overlapping the measurement year

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Patients who had documentation of use of anticoagulant medications overlapping the measurement year.

Exclude patients whose hospice care overlaps the measurement period.

Numerator Statement:

Patients who had an active medication of aspirin or another antiplatelet during the measurement year

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Previous Version:
Improvement Notation:

Higher score indicates better quality

Guidance:

None

Quality ID: 204
Meaningful Measure: Management of Chronic Conditions

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated measure header rationale to align with most recent literature.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated header references to align with updated rationale and clinical recommendation statement.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated the Denominator Exclusion statement for patients in hospice care to better align with the logic.

    Measure Section: Denominator Exclusions

    Source of Change: JIRA (CQM-2815)

Logic

  • Replaced 'Discharge status' attribute with 'Admission Source' and 'Discharge Disposition' attributes for 'Encounter, Performed' and 'Encounter, Active' datatypes to align with QDM 5.3 changes.

    Measure Section: Denominator Exclusions

    Source of Change: Standards Update

  • Added supplemental timing attributes to most datatypes in QDM 5.3 to facilitate accurate retrieval of time related information within CQL logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specification and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Removed the 'Face-To-Face Interaction' data element and added relevant SNOMED codes to the Encounter Grouping value sets to better align between the SNOMED and CPT encounter codes.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource center (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

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 Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1264) including 7 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1265) including 11 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Acute Myocardial Infarction (2.16.840.1.113883.3.464.1003.104.12.1001): Added 1 SNOMEDCT code (15962541000119106).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Coronary Artery Bypass Graft (2.16.840.1.113883.3.464.1003.104.12.1002): Added 1 SNOMEDCT code (726011000).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Percutaneous Coronary Interventions (2.16.840.1.113883.3.464.1003.104.12.1010): Added 3 CPT codes (92980, 92982, 92995).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Aspirin and Other Antiplatelets (2.16.840.1.113883.3.464.1003.196.12.1211): Added RXNORM codes (1116635, 1666332, 197622, 199314, 309952, 309953, 309955, 329296, 333833).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Anticoagulant Medications (2.16.840.1.113883.3.464.1003.196.12.1283): Added 1 RXNORM code(1992427) and deleted 1 RXNORM code (1362061).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Removed Face-to-Face Interaction.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Ischemic Vascular Disease (2.16.840.1.113883.3.464.1003.104.12.1003): Added 32 SNOMEDCT codes and deleted 10 SNOMEDCT codes (12720001000004100, 195232006, 195235008, 230706003, 230707007, 230708002, 293821000119107, 430781000124102, 433941000124104, 93396008).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced SNOMEDCT single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

External Resources