Anticoagulation Therapy for Atrial Fibrillation/Flutter

Last updated: January 31, 2017

CMS Measure ID: CMS71v6
Version: 6
NQF Number: 0436
Measure Description:

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation 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, and a history of atrial ablation, or current or history of atrial fibrillation/flutter

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 anticoagulation therapy at hospital discharge

    Numerator Exclusions:

    Not Applicable

    Denominator Exceptions:

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

    Measure Steward: The Joint Commission
    Domain: Effective Clinical Care
    Short Name: Stroke3
    Previous Version: Anticoagulation Therapy for Atrial Fibrillation/Flutter
    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.

    Specifications

    Release Notes

    Header

    • Updated Copyright.

      Section: Copyright

      Source: Annual Update

    • Updated the Denominator header statement to better align with measure logic.

      Section: Denominator

      Source: Measure Lead

    • Incremented eMeasure Version number.

      Section: eMeasure Version number

      Source: 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.

      Section: Guidance

      Source: Measure Lead

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

      Section: Initial Population

      Source: Measure Lead

    • Update references to align with chart-abstracted measures.

      Section: Reference

      Source: Chart Abstracted Measures

    Logic

    • Added new attribute 'diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic.

      Section: Denominator

      Source: QDM Standards

    • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

      Section: Denominator

      Source: QDM Standards

    • Replaced datatypes 'Diagnosis, Inactive'; 'Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

      Section: Denominator

      Source: QDM Standards

    • 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.

      Section: Denominator

      Source: QDM Standards

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

      Section: Initial Population

      Source: 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.

      Section: Initial Population

      Source: QDM Standards

    • Added new attribute 'diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic.

      Section: QDM Data Elements

      Source: 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.

      Section: QDM Data Elements

      Source: QDM Standards

    • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

      Section: QDM Data Elements

      Source: QDM Standards

    • Replaced datatypes 'Diagnosis, Inactive'; 'Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

      Section: QDM Data Elements

      Source: QDM Standards

    Value Set

    • Value set Anticoagulant Therapy (2.16.840.1.113883.3.117.1.7.1.200): Added 2 RXNORM codes (1659195, 1659197) and deleted 18 RXNORM codes.

      Section: None

      Source: None

    • 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.

      Section: None

      Source: None

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

      Section: None

      Source: None

    • 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).

      Section: None

      Source: ICD-10 Addendum

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

      Section: None

      Source: ICD-10 Addendum

    External Resources