Aspirin Prescribed at Discharge

Acute myocardial infarction (AMI) patients who are prescribed aspirin at hospital discharge

Measure specifications are in the Public Domain.

LOINC (R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.

Aspirin therapy in patients who have suffered an acute myocardial infarction reduces the risk of adverse events and mortality. Studies have demonstrated that aspirin can reduce this risk by 20% (Antiplatelet Trialists' Collaboration, 1994). National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI (O'Gara, 2013; Jneid, 2012; and Smith, 2011).

National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI

Higher score indicates better quality

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1–157.

Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy - I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81-106.

Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE Jr, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the
American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012;60:645–81.

Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046 –99.

O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:485–510.

Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458–2473.

Exclusion element guidance: 
The intent for the exclusion for patients who are clinical trial participants was to be limited to patients participating in a clinical trial for acute myocardial infarction (AMI), ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (non-STEMI), heart attack, or acute coronary syndrome (ACS), the same conditions as covered by the measure. However, the value set specifying clinical trial participation is not limited to a specific type of trial.

Medical or patient reasons for not performing a test or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision.

All hospital discharges for acute myocardial infarction (AMI) with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission.

Patients age 18 and older with an ICD-9-CM Principal Diagnosis Code for Acute Myocardial Infarction (AMI).

Patients with Comfort Measures Only documented. 
Patients enrolled in clinical trials.
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.

Acute Myocardial Infarction patients who are prescribed aspirin at hospital discharge.

Patients with a documented Reason for No Aspirin at Discharge. This includes patients with an Aspirin allergy, patients discharged on Warfarin or other specific anticoagulant medications, patients with a hold on the administration of Aspirin medications, and patients with a medical or patient reason for not prescribing this medication.

For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

Initial Patient Population =
- AND: "Diagnosis, Active: Hospital Measures - AMI (ordinality: 'Principal')" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Encounter Inpatient" ends during "Measurement Period"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- AND:
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND: "Occurrence A of Intervention, Performed: Comfort Measures" starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
  - OR:
    - AND: "Occurrence A of Intervention, Performed: Comfort Measures" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
    - AND: "Occurrence A of Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Emergency Department Visit"
  - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Discharge To Another Hospital')"
  - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Left Against Medical Advice')"
  - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Discharged to Home for Hospice Care')"
  - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Discharged to Health Care Facility for Hospice Care')"
  - OR: "Occurrence A of Encounter, Performed: Encounter Inpatient (discharge status: 'Patient Expired')"
Numerator =
- AND: "Medication, Discharge: Hospital Measures-Aspirin" starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
Denominator Exceptions =
- AND:
  - OR:
    - AND: "Medication, Administered not done: Hospital Measures - Hold" for "Hospital Measures-Aspirin " starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND NOT: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - AND: "Occurrence A of Encounter, Performed: Emergency Department Visit" <= 1 hour(s) ends before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"
    - AND: "Medication, Administered not done: Hospital Measures - Hold" for "Hospital Measures-Aspirin " starts after start of "Occurrence A of Encounter, Performed: Emergency Department Visit"
  - OR:
    - OR: "Medication, Allergy: Aspirin Allergen"
    - OR: "Medication, Order not done: Medical Reason" for "Aspirin ingredient specific "
    - OR: "Medication, Discharge not done: Medical Reason" for "Aspirin ingredient specific "
    - OR: "Medication, Order not done: Patient Refusal" for "Aspirin ingredient specific "
    - OR: "Medication, Discharge not done: Patient Refusal" for "Aspirin ingredient specific "
    - starts before or during "Occurrence A of Encounter, Performed: Encounter Inpatient"
  - OR:
    - OR: "Medication, Discharge: Warfarin"
    - OR: "Medication, Discharge: Other Anticoagulants for AMI"
    - starts during "Occurrence A of Encounter, Performed: Encounter Inpatient"

"Diagnosis, Active: Hospital Measures - AMI" using "Hospital Measures - AMI Grouping Value Set (2.16.840.1.113883.3.666.5.3011)"
"Encounter, Performed: Emergency Department Visit" using "Emergency Department Visit SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.292)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient SNOMEDCT Value Set (2.16.840.1.113883.3.666.5.307)"
"Intervention, Performed: Comfort Measures " using "Comfort Measures SNOMEDCT Value Set (1.3.6.1.4.1.33895.1.3.0.45)"
"Medication, Administered not done: Hospital Measures - Hold" using "Hospital Measures - Hold SNOMEDCT Value Set (2.16.840.1.113883.3.666.5.1145)"
"Medication, Administered: Hospital Measures-Aspirin" using "Hospital Measures-Aspirin RXNORM Value Set (2.16.840.1.113883.3.666.5.626)"
"Medication, Allergy: Aspirin Allergen" using "Aspirin Allergen RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.139)"
"Medication, Discharge not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Discharge not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Discharge: Aspirin ingredient specific" using "Aspirin ingredient specific RXNORM Value Set (2.16.840.1.113762.1.4.1021.3)"
"Medication, Discharge: Hospital Measures-Aspirin" using "Hospital Measures-Aspirin RXNORM Value Set (2.16.840.1.113883.3.666.5.626)"
"Medication, Discharge: Other Anticoagulants for AMI" using "Other Anticoagulants for AMI RXNORM Value Set (2.16.840.1.113762.1.4.1045.31)"
"Medication, Discharge: Warfarin" using "Warfarin RXNORM Value Set (2.16.840.1.113883.3.117.1.7.1.232)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.473)"
"Medication, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"
"Medication, Order: Aspirin ingredient specific" using "Aspirin ingredient specific RXNORM Value Set (2.16.840.1.113762.1.4.1021.3)"
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
"Patient Characteristic Clinical Trial Participant: Clinical Trial Participant" using "Clinical Trial Participant SNOMEDCT Value Set (2.16.840.1.113883.3.526.2.643)"
Attribute: "Discharge status: Discharge To Another Hospital" using "Discharge To Another Hospital SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.87)"
Attribute: "Discharge status: Discharged to Health Care Facility for Hospice Care" using "Discharged to Health Care Facility for Hospice Care SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.207)"
Attribute: "Discharge status: Discharged to Home for Hospice Care" using "Discharged to Home for Hospice Care SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.209)"
Attribute: "Ordinality: Principal" using "Principal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.14)"
Attribute: "Discharge status: Patient Expired" using "Patient Expired SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.309)"
Attribute: "Discharge status: Left Against Medical Advice" using "Left Against Medical Advice SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.308)"

"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"

Acute Myocardial Infarction (AMI)

eMeasure Title	Aspirin Prescribed at Discharge
eMeasure Identifier (Measure Authoring Tool)	100	eMeasure Version number	3
NQF Number	0142	GUID	bb481284-30dd-4383-928c-82385bbf1b17
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	Oklahoma Foundation for Medical Quality
Measure Developer	Oklahoma Foundation for Medical Quality
Endorsed By	National Quality Forum
Description	Acute myocardial infarction (AMI) patients who are prescribed aspirin at hospital discharge
Copyright	Measure specifications are in the Public Domain. LOINC (R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer	None
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Aspirin therapy in patients who have suffered an acute myocardial infarction reduces the risk of adverse events and mortality. Studies have demonstrated that aspirin can reduce this risk by 20% (Antiplatelet Trialists' Collaboration, 1994). National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI (O'Gara, 2013; Jneid, 2012; and Smith, 2011).
Clinical Recommendation Statement	National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI
Improvement Notation	Higher score indicates better quality
Reference	Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1–157.
Reference	Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy - I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81-106.
Reference	Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE Jr, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non–ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012;60:645–81.
Reference	Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046 –99.
Reference	O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:485–510.
Reference	Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458–2473.
Definition	None
Guidance	Exclusion element guidance: The intent for the exclusion for patients who are clinical trial participants was to be limited to patients participating in a clinical trial for acute myocardial infarction (AMI), ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (non-STEMI), heart attack, or acute coronary syndrome (ACS), the same conditions as covered by the measure. However, the value set specifying clinical trial participation is not limited to a specific type of trial. Medical or patient reasons for not performing a test or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision.
Transmission Format	None
Initial Patient Population	All hospital discharges for acute myocardial infarction (AMI) with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission.
Denominator	Patients age 18 and older with an ICD-9-CM Principal Diagnosis Code for Acute Myocardial Infarction (AMI).
Denominator Exclusions	Patients with Comfort Measures Only documented. Patients enrolled in clinical trials. 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	Acute Myocardial Infarction patients who are prescribed aspirin at hospital discharge.
Numerator Exclusions	None
Denominator Exceptions	Patients with a documented Reason for No Aspirin at Discharge. This includes patients with an Aspirin allergy, patients discharged on Warfarin or other specific anticoagulant medications, patients with a hold on the administration of Aspirin medications, and patients with a medical or patient reason for not prescribing this medication.
Measure Population	Not applicable
Measure Observations	Not applicable
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

Table of Contents

Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements