eMeasure Title

Discharged on Statin Medication

eMeasure Identifier (Measure Authoring Tool) 105 eMeasure Version number 5.3.000
NQF Number 0439 GUID 1f503318-bb8d-4b91-af63-223ae0a2328e
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward The Joint Commission
Measure Developer The Joint Commission
Endorsed By National Quality Forum
Description
Ischemic stroke patients who are prescribed statin medication 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.
Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Non-Elective Inpatient Encounter
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
There is an extensive and consistent body of evidence supporting the use of statins for secondary prevention in patients with clinically evident atherosclerotic cardiovascular disease (ASCVD), which includes individuals with ischemic stroke due to large artery atherosclerosis, individuals with ischemic stroke due to intrinsic small vessel disease, and individuals with ischemic stroke not directly due to atherosclerosis but with clinically evident atherosclerotic disease in an uninvolved cerebral or noncerebral bed.  Both women and men with clinical ASCVD are at increased risk for recurrent ASCVD and ASCVD death.  High-intensity statin therapy should be initiated or continued as first-line therapy in women and men less than or equal to 75 years of age who have clinical ASCVD, unless contraindicated. In patients with clinical ASCVD and a contraindication to high-intensity statin therapy, moderate-intensity therapy should be considered as an alternative if it can be tolerated.  In individuals greater than 75 years of age, the potential for ASCVD risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences should be considered, and statin therapy individualized based on these considerations (Stone, 2013).
Clinical Recommendation Statement
For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated
Improvement Notation
Improvement noted as an increase in rate
Reference
Stone NJ, Robinson J, Lichtenstein AH, Noel Bairey Merz C, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero Jr, ST, Smith SC, Watson K, Wilson PWF. "Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines." [In eng]. Circulation 11, (Nov 2013): 1-84. 
Reference
Amarenco, P., J. Bogousslavsky, A. Callahan, 3rd, L. B. Goldstein, M. Hennerici, A. E. Rudolph, H. Sillesen, et al. "High-Dose Atorvastatin after Stroke or Transient Ischemic Attack." [In eng]. N Engl J Med 355, no. 6 (Aug 10 2006): 549-59
Reference
Feher, A., G. Pusch, K. Koltai, A. Tibold, B. Gasztonyi, L. Szapary, and G. Feher. "Statintherapy in the Primary and the Secondary Prevention of Ischaemic Cerebrovascular Diseases." [In eng]. Int J Cardiol 148, no. 2 (Apr 14 2011): 131-8.
Reference
Kernan, W.N., B. Ovbiagele, H. R. Black, D. M. Bravata, M. I. Chimowitz, M. D. Ezekowitz, M. C. Fang, M. Fisher, K. L. Furie, D. V. Heck, S. C. Johnston, S. E. Kasner, S. J. Kittner, P. H. Mitchell, M. W. Rich, D. Richardson, L. H. Schwamm, J. A. Wilson. "Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [in eng.]  Stroke 45, no. 7 (May 2014): 2160-223
Reference
National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults."Third Report of the National Cholesterol Education Program (Ncep) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Iii) Final Report." [In eng]. Circulation 106, no. 25 (Dec 17 2002): 3143-421.
Reference
Squizzato, A., E. Romualdi, F. Dentali, and W. Ageno. "Statins for Acute Ischemic Stroke." [In eng]. Cochrane Database Syst Rev, no. 8 (2011): CD007551.
Definition
None
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.
Transmission Format
TBD
Initial 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
Patients with a principal diagnosis of ischemic stroke
Denominator Exclusions
*Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.
*Patients with comfort measures documented
*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
*Patients with an LDL-c of less than 70 mg/dL <30 days prior to arrival or any time during the hospital stay
Numerator
Patients prescribed statin medication at hospital discharge
Numerator Exclusions
Not Applicable
Denominator Exceptions
Patients with a reason for not prescribing statin medication at discharge
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
eMeasure Stroke (eSTK)