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Primary PCI Received Within 90 Minutes of Hospital Arrival

Last updated: September 14, 2018

CMS Measure ID: CMS53v7
Version: 7
NQF Number: None
Measure Description:

Acute myocardial infarction (AMI) patients with a diagnostic ECG and ST-segment elevation, who receive a primary percutaneous coronary intervention (PCI) during their hospital stay, and the time from hospital arrival to PCI is 90 minutes or less

Initial Patient Population:

Patients age 18 and older at the time of hospital admission with a principal diagnosis of an Acute or Evolving Myocardial Infarction (ST-segment elevation MI) with hospital stays <= 120 days during the measurement period

Denominator Statement:

Initial populationinfo-icon with an ECG performed and a primary PCI procedure closest to the inpatient admission that does not start after fibrinolytic therapy

Denominator Exclusions:

Patients who transferred from another hospital's inpatient, outpatient, or emergency department and ambulatory surgery center facilities are excluded

Numerator Statement:

Initial populationinfo-icon whose time from hospital arrival to primary PCI is 90 minutes or less

Numerator Exclusions:

Not applicable

Denominator Exceptions:

Patients who did not receive PCI within 90 minutes and have a documented reason. Documented reasons include:

Diagnosis: Cardiopulmonary arrest

Procedure, Performed: Endotracheal Intubation

Procedure, Performed: Aortic balloon pump insertion

Procedure, Performed: Ventricular Assist Device placement

Measure Steward: Centers for Medicare & Medicaid Services (CMS)
Short Name: AMI-8a
Previous Version:
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

To identify the ECG closest to hospital arrival, the denominatorinfo-icon will identify the most recent ECG performed that starts less than 1 hour prior to the emergency department (ED) or inpatient encounter OR the first ECG performed starts after the ED or inpatient encounter started.

PCI procedures analyzed in this measure must be primary procedures. Primary includes emergent or urgent PCI procedures and not those described by the physician/APN/PA anywhere in the record as elective, not emergent, not immediate, not primary, not urgent, or secondary.

From a clinical standpoint, Primary PCI is loosely defined as percutaneous coronary intervention performed in the acute setting in patients with ST-segment elevation MI which is intended to restore perfusion in the infarct-related artery.

Meaningful Measure: Preventive Care

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated the measure description to make the language clear and concise. This is a language update only.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Removed guidance statement related to the inability to explicitly express the primary percutaneous coronary intervention (PCI) with QDMinfo-icon-based logic because the measure is now expressed using CQLinfo-icon and this is no longer an issue.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • ​Updated the numeratorinfo-icon statement to better align with the CQL-based logic and for consistency with the denominatorinfo-icon statement.​

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Removed the QDM subset operator ‘Most Recent’ since timing in CQL only requires ‘First’ to capture the intent.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Removed 'Transfer from' datatype to conform with QDM 5.3 changes.

    Measure Section: Denominator Exclusionsinfo-icon

    Source of Change: Standards Update

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

    Measure Section: Denominator Exclusions

    Source of Change: Standards Update

  • Modeled the Location attribute for Encounter, Performed to allow for describing the patient’s presence in more than one location during an individual Encounter to conform with QDM 5.3 changes.

    Measure Section: Numerator

    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 specificationinfo-icon 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

  • 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 centerinfo-icon (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 Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set Endotracheal Intubation (2.16.840.1.113762.1.4.1045.69): Added 3 ICD10PCS codes (0B110F4, 0B113F4, 0B114F4).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Acute or Evolving MI (2.16.840.1.113883.3.666.5.3022): Added 1 SNOMEDCT code (15962541000119106).

    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 Acute or Evolving MI (2.16.840.1.113883.3.666.5.3022): Added 1 SNOMEDCT code (15963181000119104).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set PCI (2.16.840.1.113762.1.4.1045.67): Added 1 SNOMEDCT code (737085003).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources