eMeasure Title

Aspirin Prescribed at Discharge

eMeasure Identifier (Measure Authoring Tool) 100 eMeasure Version number 5.2.000
NQF Number 0142 GUID bb481284-30dd-4383-928c-82385bbf1b17
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
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 2004-2015 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.  The measures and specifications are provided without warranty.  CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.
Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Encounter Inpatient
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
Improvement noted as an increase in rate
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
Initial population guidance:
Includes patients with a principal diagnosis of AMI during an emergency department visit less than or equal to one hour before the inpatient admission.

Exclusion element guidance: 
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 Population
Patients age 18 and older at the time of hospital admission with a principal diagnosis of Acute Myocardial Infarction (AMI) and a length of stay less than or equal to 120 days, during the measurement period
Denominator
Equals Initial Population
Denominator Exclusions
Patients with Comfort Measures documented
Patients discharged to another acute care facility
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 prescribed aspirin at hospital discharge
Numerator Exclusions
Not Applicable
Denominator Exceptions
Patients with a documented reason for not prescribing aspirin at discharge. This includes patients with an aspirin allergy; discharged on warfarin or other specific anticoagulant medications; the administration of aspirin medications are on HOLD; or a medical or patient reason for not prescribing aspirin.
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 Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
Acute Myocardial Infarction (AMI)