eCQM Title

Discharged on Statin Medication

eCQM Identifier (Measure Authoring Tool) 105 eCQM Version number 8.1.000
NQF Number Not Applicable 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 None
Description
Ischemic stroke patients who are prescribed or continuing to take statin medication at hospital discharge
Copyright
LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. 
This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. All Rights Reserved.

Measure specifications are in the Public Domain.
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
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
Amarenco, P., Bogousslavsky, J., Callahan, A., III, et al. (2006, August 10). High-dose atorvastatin after stroke or transient ischemic attack. New England Journal of Medicine, 355(6), 549-559. 
Reference
Biffi, A., Devan, W. J., Anderson, C. D., et al. (2011, May). Statin treatment and functional outcome after ischemic stroke: Case-control and meta-analysis. Stroke, 42(5), 1314-1319. 
Reference
Centers for Disease Control and Prevention. (2009, May 1). Prevalence and most common causes of disability among adults—United States, 2005. Morbidity and Mortality Weekly Report, 58(16), 421-426. 
Reference
Chan, P. S., Nallamothu, B. K., Gurm, H. S., et al. (2007, May 8). Incremental benefit and cost-effectiveness of high-dose statin therapy in high-risk patients with coronary artery disease. Circulation, 115(18), 2398-2409. 
Reference
Culver, A. L., Ockene, I. S., Balasubramanian, R., et al. (2012, January 23). Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Archives of Internal Medicine, 172(2),  144-152. 
Reference
Feher, A., Pusch, G., Koltai, K., et al. (2011, April 14). Statin therapy in the primary and the secondary prevention of ischaemic cerebrovascular diseases. International Journal of Cardiology, 148(2), 131-138. 
Reference
Grundy, S. M., Cleeman, J. I., Merz, C. N., et al. (2004, July 13). Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2), 227-239. 
Reference
Kernan, W. N., Ovbiagele, B., Black, H. R., et al. (2014, May). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 45(7), 2160-2223. 
Reference
Kostis, W. J., Cheng, J. Q., Dobrzynski, J. M., et al. (2012, February 7). Meta-analysis of statin effects in women versus men. Journal of the American College of Cardiology, 59(6), 572-582.
Reference
Lazar, L. D., Pletcher, M. J., Coxson, P. G., et al. (2011, July 12). Cost-effectiveness of statin therapy for primary prevention in a low-cost statin era. Circulation, 124(2), 146-153.
Reference
Mitka, M. (2012, March 7). Some question use of statins to reduce cardiovascular risks in healthy women. JAMA, 307(9), 893-894. 
Reference
National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults. (2002, December 17). 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. Circulation, 106(25), 3143-3421. 
Reference
Powers, W. J., Rabinstein, A. A., Ackerson, T., et al. (2018, January). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 49, e44-e47. 
Reference
Rodriguez-Yanez, M., Agulla, J., Rodriguez-Gonzalez, R., et al. (2008, June). Statins and stroke. Therapeutic Advances in Cardiovascular Disease, 2(3), 157-166. 
Reference
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., et al. (2012, January 3). Heart disease and stroke statistics—2012 update: A report from the American Heart Association. Circulation, 125(1), e2-e220. 
Reference
Schellinger, P. D., Bryan, R. N., Caplan, L. R., et al. (2010, July 13). Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology, 75(2), 177-185.
Reference
Squizzato, A., Romualdi, E., Dentali, F., et al. (2011). Statins for acute ischemic stroke. Cochrane Database of Systematic Reviews, 8, CD007551. 
Reference
Stone, N. J., Robinson, J., Lichtenstein, A. H., et al. (2013, November). 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. Circulation, 11, 1-84. 
Reference
Van Dis, F. J., Keilson, L. M., Rundell, C. A., et al. (1996, June). Direct measurement of serum low-density lipoprotein cholesterol in patients with acute myocardial infarction on admission to the emergency room. American Journal of Cardiology, 77(14), 1232-1234. 
Reference
Weiss, R., Harder, M., & Rowe, J. (2003, May). The relationship between nonfasting and fasting lipid measurements in patients with or without type 2 diabetes mellitus receiving treatment with 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitors. Clinical Therapeutics, 25(5), 1490-1497. 
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 Inpatient Encounters include emergency, urgent, and unplanned admissions.

The "Medication, Discharge" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.
Transmission Format
TBD
Initial Population
Inpatient hospitalizations for 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 that ends during measurement period
Denominator
Inpatient hospitalizations for patients with a principal diagnosis of ischemic stroke
Denominator Exclusions
Inpatient hospitalizations for patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations.
Inpatient hospitalizations for patients discharged to another hospital
Inpatient hospitalizations for patients who left against medical advice
Inpatient hospitalizations for patients who expired
Inpatient hospitalizations for patients discharged to home for hospice care
Inpatient hospitalizations for patients discharged to a health care facility for hospice care
Inpatient hospitalizations for patients with comfort measures documented
Numerator
Inpatient hospitalizations for patients prescribed or continuing to take statin medication at hospital discharge
Numerator Exclusions
Not Applicable
Denominator Exceptions
Inpatient hospitalizations for patients with a reason for not prescribing statin medication at discharge
Inpatient hospitalizations for patients with a maximum LDL-c result of  less than 70 mg/dL <= 30 days prior to arrival or any time during the hospital stay
Inpatient hospitalizations for patients with a statin allergy.
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents


Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
eMeasure Stroke (eSTK)