Last updated: June 9, 2017
| CMS Measure ID: | CMS53v6 |
|---|---|
| Version: | 6 |
| NQF Number: | None |
| Measure Description: |
Acute myocardial infarction (AMI) patients with ST-segment elevation on the ECG closest to arrival time receiving primary PCI during the hospital stay with a time from hospital arrival to PCI of 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 population 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: |
AMI patients 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: | AMI8a |
| Previous Version: | Primary PCI Received Within 90 Minutes of Hospital Arrival |
| Improvement Notation: |
Improvement noted as an increase in rate |
| Guidance: |
To identify the ECG closest to hospital arrival, the denominator 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. There is currently no way to explicitly express this in QDM, however, using 'FIRST' will likely capture the intent in the majority of cases. |
Specifications
CMS53v6.html
CMS53v6.xml- CMS53v6_SimpleXML.xml
EH_CAH_CMS53v6_NQFXXXX_AMI8a_PrimaryPCI.zip
CMS53v6_TRN_05.05.17.xlsx
Release Notes
Header
Incremented eMeasure Version number.
Section: eMeasure Version number
Source: Measure Lead
Updated Copyright.
Section: Copyright
Source: Annual Update
Replaced NQF Number '0163' with 'Not Applicable' as the measure is no longer endorsed.
Section: NQF Number
Source: Measure Lead
Replaced 'National Quality Forum' with 'None' as the measure is no longer endorsed.
Section: Endorsed By
Source: Measure Lead
Changed measurement year to measurement period to be consistent with logic changes and harmonize across measures.
Section: Initial Population
Source: Measure Lead
Updated the Initial Population narrative statement by changing the principal diagnosis from Acute Myocardial Infarction to Acute or Evolving Myocardial Infarction, adding clarification that the Acute or Evolving is an ST-segment elevation MI.
Section: Initial Population
Source: Measure Lead
Updated the Denominator narrative statement by adding ECG performed and removing the result: Acute or Evolving to be consistent with logic changes.
Section: Denominator
Source: Measure Lead
Changed 'has' to 'have' to improve the sentence structure. Sentence now reads 'Patients who did not receive PCI within 90 minutes and have a documented reason.'
Section: Denominator Exceptions
Source: Measure Lead
Logic
Changed the principal diagnosis from Acute Myocardial Infarction (AMI) to Acute or Evolving Myocardial Infarction to simplify the logic while meeting the intent of the measure to capture ST-segment elevation MIs.
Section: Initial Population
Source: JIRA (CQM-2220)
Removed two lines of logic: 'Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: Acute or Evolving MI)' and AND NOT: 'Occurrence A of Diagnostic Study, Performed: Electrocardiogram (ECG) (result: STEMI Exclusions)' to simplify the logic. The ECG result of Acute or Evolving is no longer needed since the Initial Population now captures the Acute or Evolving MI cases. The STEMI exclusions check would be redundant since only STEMI codes would be captured in the Initial Population.
Section: Denominator
Source: JIRA (CQM-2220)
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 Endotracheal Intubation (2.16.840.1.113762.1.4.1045.69): Deleted four ICD9CM codes (96.04, 96.70, 96.71, 96.72).
Section: None
Source: None
Value set Ventricular Assist Device placement (2.16.840.1.113883.3.666.5.3015): Deleted six ICD9CM codes (37.52, 37.60, 37.62, 37.65, 37.66, 37.68).
Section: None
Source: None
Value set Acute or Evolving MI (2.16.840.1.113883.3.666.5.3022): Deleted 16 ICD9CM codes.
Section: None
Source: None
Value set Fibrinolytic Therapy (2.16.840.1.113883.3.666.5.736): Added 2 RXNORM codes (1804799, 1804804) and deleted 1 RXNORM code (308056).
Section: None
Source: None
Value set Cardiopulmonary arrest (2.16.840.1.113883.3.666.5.748): Deleted 3 ICD9CM codes (427.41, 427.5, 799.1).
Section: None
Source: None
Value set PCI (2.16.840.1.113762.1.4.1045.67): Deleted 1 ICD9CM code (00.66). Added 2 SNOMEDCT codes (698740005, 707828002).
Section: None
Source: None
Removed the Acute Myocardial Infarction (AMI) Grouping Value Set (2.16.840.1.113883.3.666.5.3011) and the STEMI Exclusions Grouping Value Set (2.16.840.1.113762.1.4.1045.36) to align with logic changes.
Section: None
Source: JIRA (CQM-2220)
Removed ICD9CM extensional value sets from their associated grouping value sets as there are no lookback periods in this measure.
Section: None
Source: JIRA (CQM-2220)