eMeasure Title

Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival

eMeasure Identifier (Measure Authoring Tool) 60 eMeasure Version number 5.4.000
NQF Number Not Applicable GUID 909cf4b4-7a85-4abf-a1c7-cb597ed1c0b6
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 None
Description
Acute myocardial infarction (AMI) patients with ST-segment elevation on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less.
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
Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. Nearly 2 lives per 1000 patients are lost per hour of delay (Fibrinolytic Therapy Trialists' Collaborative Group, 1994). National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-elevation myocardial infarction (O'Gara, 2013).
Clinical Recommendation Statement
National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-elevation myocardial infarction.
Improvement Notation
Improvement noted as an increase in rate
Reference
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.
Reference
Fibrinolytic Therapy Trialists (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet. 1994;343:311-22.
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.
Definition
None
Guidance
To identify the ECG closest to the 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 that starts after the ED or inpatient encounter started.
Transmission Format
TBD
Initial Population
Patients age 18 and older at the time of hospital admission with a principal diagnosis of Acute Myocardial Infarction (AMI) with hospital stays <= 120 days during the measurement year
Denominator
Includes Initial Population, and patients with an ECG result of acute or evolving MI, who received fibrinolytic therapy 360 minutes starting after the hospital arrival
Denominator Exclusions
Patients who transferred from an inpatient, outpatient, emergency department or ambulatory surgery center are excluded
Numerator
AMI patients whose time from hospital arrival to fibrinolysis is 30 minutes or less
Numerator Exclusions
Not Applicable
Denominator Exceptions
Patients who did not receive fibrinolytic therapy within 30 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"
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)