JCI I-AMI-1 ASA on Arrival Specifications SAMPLE 2012

7/25/2019 JCI I-AMI-1 ASA on Arrival Specifications SAMPLE 2012

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Specification Manual for the Joint Commission International Library of MeasuresVersion 2.0, effective for January 2013 discharges (1st Quarter 2013)2011 Joint Commission International

Joint Commission

InternationalAcute Myocardial Infarction

(I-AMI) Measure Set


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Contents

I-AMI Hospital Inpatient Quality Measures .................................................................................... 2I-AMI Data Element/Variable List ..................................................................................................4I-AMI Initial Eligible Patient Population Criteria.............................................................................. 5I-AMI Initial Eligible Patient Population Word Algorithm .................................................................6Measure Inform ation Form s (includin g Information Form s, Overviews, Detai ls, References,

Flowch arts, Word Alg ori thm s, and Appendices)

I-AMI-1: Aspirin on Arrival .................................................................................................. 7I-AMI-2: Aspirin Prescribed at Discharge .................................................................................... 15I-AMI-3: ACEI of ARB for LVSD ......................................................................................... 22I-AMI-4: Adult Smoking Counseling ................................................................................... 33

I-AMI-5: Beta Blocker Prescribed at Discharge .................................................................. 41I-AMI-9: Inpatient AMI Mortality ......................................................................................... 48

Appendix A: International Classification of Diseases (ICD) Code Tables ........................... 55


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Joint Commission International Acute Myocardial Infarction (I-AMI)Hospital Inpatient Quality Measures

I-Acute Myocardial Infarction (I-AMI)Measure Code Measure Short Name Measure Description

I-AMI-1 Aspirin at Arrival Aspirin received within 24 hours of arrival the hospital for patients having an AcuteMyocardial Infarction (AMI).

I-AMI-2 Aspirin Prescribed at Discharge Aspirin prescribed at discharge for patientwho had an Acute Myocardial Infarction(AMI).

I-AMI-3 ACEI or ARB for LVSD ACEI (Angiotensin Converting EnzymeInhibitor) or ARB (Angiotensin Receptor

Blocker) for patients who have LVSD (LeftVentricular Systolic Dysfunction) afterhaving an Acute Myocardial Infarction.

I-AMI-4 Adult Smoking CessationAdvice/Counseling

Adult Smoking Cessation (cigarette)advice/counseling given to patients whohad an Acute Myocardial Infarction.

I-AMI-5 Beta Blocker Prescribed atDischarge

Beta blocker prescribed at discharge forpatients who had an Acute MyocardialInfarction (AMI).

I-AMI-9 Inpatient Mortality Acute Myocardial Infarction (AMI) patientswho expire during the hospital stay


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I-AMI Data Element/Variable List

General Data Element Name Collected For:

Admission Date All measures

Birthdate All measures

Discharge Date All measures

Hospital Patient Identifier All measures

ICD Other Diagnosis Code All measures

ICD Principal Diagnosis Code All measures

Sex All measures

Data Element Name Collected For:

ACEI Prescribed at Discharge I-AMI-3Adult Smoking Counseling I-AMI-4

Adult Smoking History I-AMI-4

ARB Prescribed at Discharge I-AMI-3

Arrival Date I-AMI-1

Aspirin Prescribed at Discharge I-AMI-2

Aspirin Received Within 24 Hours Before or AfterHospital Arrival

I-AMI-1

Beta Blocker Prescribed at Discharge I-AMI-5

Discharge Disposition I-AMI-1, I-AMI-2, I-AMI-3, I-AMI-4, I-AMI-I-AMI-9

LVSD I-AMI-3Reason for No ACEI and No ARB at Discharge I-AMI-3

Reason for No Aspirin at Discharge I-AMI-2

Reason for No Aspirin on Arrival I-AMI-1

Reason for No Beta Blocker at Discharge I-AMI-5

Transfer From Another Hospital I-AMI-9


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I-AMI Initial Eligible Patient Population Criteria

The population of the I-AMI measure set is identified using 4 data elements/variables:

ICD Principal Diagnosis Code

Admission Date

Birthdate

Discharge Date

Patients admitted to the hospital for inpatient acute care with an ICD Principal Diagnosis

Code or principal diagnosis of Acute Myocardial Infarction (AMI) as defined inAppendix

A, Table 1.1ANDa Patient Age (Admission Date minus Birthdate) greater than or equal

to 18 years of age are included in the I-AMI Initial Patient Population and are

eligible to be sampled.

For more information on sampling, go to Appendix I: Measure Sampling.


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I-AMI Initial Eligible Patient Population Word AlgorithmVariable Key: Patient Age, and Initial Population Reject Case

1. Start AMI Initial Patient Population logic sub-routine. Process all quarterly dischargeinpatient cases (cases with discharge dates in the specific data collection time period)that have successfully reached the point in the Data Processing Flow: Do not processcases that have been rejected before this point in the Data Processing Flow.

2. Check ICD Principal Diagno sis Cod ea. If the ICD Principal Diagnosis Code is not on Table 1.1, the patient is not in the AMI

Initial Patient Population and is not eligible to be sampled for the AMI measure set.

Set the Initial Patient Population to equal reject case. Return to Data ProcessingFlow.

b. If the ICD Principal Diagnosis Code is on Table 1.1, continue processing andproceed to Patient Age calculation.

3. Calculate Patient Age. Patient Age, in years, is equal to the Admission Date minus theBirthdate. Use the month and day portion of Admission Date and Birthdate to yield themost accurate age.

4. Check Patient Agea. If the Patient Age is less than 18 years, the patient is not in the I-AMI Initial Patient

Population and is not eligible to be sampled for the I-AMI measure set. Set the InitialPatient Population to equal reject case. Return to Data Processing Flow.b. If the Patient Age is greater than or equal to 18 years, continue processing and

proceed to each measures Clinical Data Processing Flow.


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I-AMI-1: Aspirin on Arrival

Measure Overview

I-AMI-1 Aspirin received within 24 hours of arrival to the hospital for patientshaving an Acute Myocardial Infarction.

Overview/Details:Aspirin received within 24 hours of arrival to the hospital for patients having an AcuteMyocardial Infarction (AMI).

Rationale:The early use of aspirin in patients with Acute Myocardial Infarction results in asignificant reduction in adverse events and subsequent mortality.

Measure-Related OutcomesMortality: Decreased mortalityReadmissions within 30 days: DecreasedReliability: Increased delivery of evidence based careImprovement noted as: Increase in rate

Patient Settings/Services:Emergency Services/DepartmentIntensive Care Units

Medical/Surgical units

Indicator Name: Aspirin on arrival

Numerator: AMI patients who received aspirin within 24 hours beforeor after hospital arrival

Denominator: AMI patients who are age >= 18 years


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Measure-RelatedDomains of

Performance

Measure-RelatedQuality Improvement and

Patient Safety (QPS)Standards

QPS.3 through QPS.3.3 IntentStatement Clinical Areas

Measure-RelatedClinical

CareProgram

Certification

Measure-Topic

RelatedI-PatientSafetyGoals

Appropriateness

Availability

Continuity

Effectiveness

Timeliness

QPS.3.1

1. patient assessments

5. antibiotic and other

medication use

AMI Goal 1


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I-AMI-1

Measure Details

Reasons and Implications: The benefits of aspirin therapy on mortality arecomparable to fibrinolytic therapy. The combination of aspirin and fibrinolytics providesadditive benefit for patients with ST-elevation myocardial infarction and aspirin is alsoeffective in patients with non-ST-elevation Myocardial Infarction. Clinical guidelinesstrongly recommend aspirin for patients hospitalized with AMI.

Data Collection:Retrospective data sources for the required data elements include administrative dataand medical records.

Numerator: AMI patients who received aspirin within 24 hours before or after hospitalarrival

Data Elements:

Aspirin Received Within 24 Hours Before or After Hospital Arrival

Inclusions to the numerator population: Not Applicable

Exclusions from the numerator population: None

Denominator: AMI patients who are >= 18 years

Data Elements:

Arrival Date

Birthdate

Discharge Disposition

ICD Principal Diagnosis Code

Reason for No Aspirin on Arrival

Inclusions to the denominator population: Patients with ICD Principal DiagnosisCodefor AMI as defined inAppendix A, Table 1.1.

Exclusions from the denominator population: Patients less than 18 years of age

Patients who left against medical advice

Patients who expired on day of or day after arrival


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Patients with a documented Reason for No Aspirin on Arrival

Patients discharged/transferred to another hospital for inpatient care


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I-AMI-1

References

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 unstableangina/nonST-elevation myocardial infarction: a report of the American Collegeof Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 2002 Guidelines for the Management of PatientsWith Unstable Angina/NonST-Elevation Myocardial Infarction): developed incollaboration with the American College of Emergency Physicians, AmericanCollege of Physicians, Society for Academic Emergency Medicine, Society forCardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.J Am Coll Cardiol.2007;50:e1157.

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 myocardialinfarction: a report of the American College of Cardiology/American Heart

Association Task Force on Practice Guidelines (Committee to Revise the 1999Guidelines for the Management of Patients With Acute Myocardial Infarction).2004.

Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, etal. ACC/AHA 2008 performance measures for adults with ST-elevation and nonST-elevation myocardial infarction: a report of the American College ofCardiology/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;52:204699. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among

17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (SecondInternational Study of Infarct Survival) Collaborative Group. Lancet. 1988 Aug13;2(8607):349w-60.

Risk of myocardial infarction and death during treatment with low dose aspirin andintravenous heparin in men with unstable coronary artery disease. The RISCGroup. Lancet. 1990;336(8719):827-830.

Theroux P, Ouimet H, McCans J et al. Aspirin, heparin, or both to treat acuteunstable angina. N Engl J Med.1988;319(17):1105-1111.


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ICD Principal

Diagnosis Code

for Acute Myocardial

Infarction(AMI)

Patient Age

Aspirin

Received Within 24

Hours Before or After

Hospital Arrival

Reason for

No Aspirin on

Arrival

YES

NO

NO

Case NOT in the I-AMI

Initial Population

Case NOT in the I-AMI

Initial Population

Case Met Measure and is in

the NumeratorPopulation (E)

Case Did Not Meet the

Measure and is in the Measure

Population (D)

NO

< 18 years

YES

YES

Run inpatient cases with ICD Principal

Diagnosis Code or principal diagnosis

of AMI, Appendix A, Table 1.1

Patient Age (in years) =

Admission DateBirthdate

Run case for patients = > 18 years old

Check if aspirin was received within 24

hours before or after hospital arrival

Check if theres a documented reason

for no aspirin on arrival

I-AMI-1 Aspirin on Arrival

Discharge

Disposition

START

2, 3, or 4a

Check if patient expired on the day of

or day after arrival or signed out of the

hospital against medical advice (AMA)

or was transferred to another hospital

for inpatient care

Arrival Date

Case Did Not Meet the

Measure and is in the

Measure

Population (D)

UTDCheck what the earliest documented

date the patient arrived at the hospital

Case Not in Measure

Population-Excluded (B)

Case Not in Measure

Population-Excluded (B)

= > 18years

Valid Date

1, 4b, 5, or 6

STOP


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I-AMI-1 Aspirin at ArrivalWord Algorithm

Numerator:Acute Myocardial Infarction (AMI) patients who received aspirin within 24 hoursbefore or after hospital arrival

Denominator:AMI patients

1. Start processing. Run cases that are included in the I-AMI Initial Patient Populationand pass the edits defined in the Data Processing Flow: Clinical data abstractionthrough this measure.

2. Check Arr ival Date

a. If Arrival Date equals Unable to Determine (UTD), the case will proceed to aMeasure Category Assignment of D and will be in the Measure Population.Stop processing.

b. If Arrival Date equals a Non Unable to Determine value, continue processing andproceed to the check Discharge Disposition.

3. Check Discharge Dispos it ion.a. If the Discharge Disposition equals 2, 3, or 4a, the case will proceed to a Measure

Category Assignment of B and will not be in the measure population. Stopprocessing.

b. If the Discharge Status is equals 1, 4b, 5, or 6, continue processing and proceed toAspirin Received Within 24 Hours Before or After Hospital Arrival.

4. Check Asp ir in Received Within 24 HoursBefore or After Hosp ital Arr ivala. If Aspirin Received Within 24 Hours Before or After Hospital Arrival equals yes, the

case will proceed to a Measure Category Assignment of E and will be in theNumerator Population. Stop processing.

b. If Aspirin Received Within 24 Hours Before or After Hospital Arrival equals No,continue processing and proceed to check Reason for No Aspirin on Arrival.

5. Check Reason for No A spir in on Arr iva la. If Reason for No Aspirin on Arrival equals Yes, the case will proceed to a Measure

Category Assignment of B and willnot be in the Measure Population. Stop

processing.b. If Reason for No Aspirin on Arrival equals No, the case will proceed to a MeasureCategory Assignmentof D and will be in the Measure Population. StopProcessing


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Measure Calculation:

After the case data abstraction and data flow is completed, circle the assignedMeasure Category Assignment (MCA)Letter for each measure as guided by theallowable answer value text:

I-AMI-1 B-Excluded D-Not metmeasure*

E-Met/Passedmeasure**

When calculating measure rate for all abstracted cases in the discharge month:Numerator cases = EDenominator cases = D plus E

Divide the numerator counts by the denominator counts and X 100 = percentage

rate of measure compliance with recommended standard of care

Glossary Terms:*Not Met Measurerefers to a medical record which does not contain all of the criteriarequired to be part of the measures numerator population. **Met Measurerefers to a medical record which contains all of the criteria required tobe part of the measures numerator population.

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JCI I-AMI-1 ASA on Arrival Specifications SAMPLE 2012