ecqm.measure

CMS104v7 - Discharged on Antithrombotic Therapy (STK-02)

Rationale:

Discharged on Antithrombotic Therapy (STK-02). The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. For patients with a stroke due to a cardioembolic source (eg atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.

Data Elements

NonElectiveInpatientEncounterPerformed

Clinical Focus: This set of values contains procedures that represent non-elective inpatient encounters.

Data Element Scope: The intent of this data element is to identify non-elective inpatient encounters. Using the Quality Data Model, this particular element will map to the 'Encounter' category.

Inclusion Criteria: Only SNOMED CT codes representing non-elective inpatient encounter should be included.

Exclusion Criteria: None

Subject constrained to the Non-Elective Inpatient Encounter

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

NonElectiveInpatientEncounterPerformed

0..*

DischargedToHealthCareFacilityForHospiceCareDischargeDisposition

Clinical Focus: This set of values contains procedures used to represent the discharge of a patient to a health care facility for hospice care.

Data Element Scope: The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who where discharged to a health care facility for hospice care. Using the Quality Data Model, this particular value set is used with the Attribute of 'Discharge status' used with the 'Encounter' category.

Inclusion Criteria: Only SNOMED CT codes representing health care facilities for hospice care should be included.

Exclusion Criteria: None

DischargeDisposition: The disposition, or location to which the patient is transferred at the time of hospital discharge.

DataType

Cardinality

DischargedToHealthCareFacilityForHospiceCareDischargeDisposition

0..*

DischargedToHomeForHospiceCareDischargeDisposition

Clinical Focus: This set of values contains procedures used to represent the discharge of a patient to home for hospice care.

Data Element Scope: The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who where discharged to home for hospice care. Using the Quality Data Model, this particular value set is used with the Attribute of 'Discharge status' used with the 'Encounter' category.

Inclusion Criteria: Only SNOMED CT codes representing discharge to home for hospice care should be included.

Exclusion Criteria: None

DischargeDisposition: The disposition, or location to which the patient is transferred at the time of hospital discharge.

DataType

Cardinality

DischargedToHomeForHospiceCareDischargeDisposition

0..*

LeftAgainstMedicalAdviceDischargeDisposition

Clinical Focus: This set of values represents a patient leaving against medical advice.

Data Element Scope: The intent of this data element is to identify the final place or setting to which the patient was discharged on the day of discharge from a particular inpatient encounter. This particular value set intends to identify patients who left against medical advice. Using the Quality Data Model, this particular value set is used with the Attribute of 'Discharge status' used with the 'Encounter' category.

Inclusion Criteria: Only SNOMED CT codes representing leaving against medical advice should be included.

Exclusion Criteria: None

DischargeDisposition: The disposition, or location to which the patient is transferred at the time of hospital discharge.

DataType

Cardinality

LeftAgainstMedicalAdviceDischargeDisposition

0..*

HemorrhagicStrokePrincipalDiagnosis

Clinical Focus: This grouping of value sets identifies patients who have had a hemorrhagic stroke, or stroke caused by hemorrhage.

Data Element Scope: The intent of this data element is to identify patients who have a diagnosis of hemorrhagic stroke, or stroke caused by a hemorrhage. Using the Quality Data Model, this particular element would map to the Principal Diagnosis attribute for the Encounter category.

Inclusion Criteria: Only use codes which represent a diagnosis of hemorrhagic stroke, or stroke caused by hemorrhage. This is a grouping of ICD10CM and SNOMED-CT codes.

Exclusion Criteria: None.

PrincipalDiagnosis: The coded diagnosis/problem established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

DataType

Cardinality

HemorrhagicStrokePrincipalDiagnosis

0..*

IschemicStrokePrincipalDiagnosis

Clinical Focus: This grouping of value sets identifies patients who have had a stroke caused by ischemia, where the blood supply is restricted to an area of the brain by something like thrombosis or an embolism.

Data Element Scope: The intent of this data element is to identify patients who have a diagnosis of ischemic stroke, or stroke caused by ischemia. Using the Quality Data Model, this particular element would map to the Principal Diagnosis attribute for the Encounter category or to the Diagnosis Category.

Inclusion Criteria: Only use codes which represent a diagnosis of ischemic stroke, or stroke caused by ischemia. This is a grouping of ICD10CM and SNOMED-CT codes and concepts.

Exclusion Criteria: None.

PrincipalDiagnosis: The coded diagnosis/problem established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

DataType

Cardinality

IschemicStrokePrincipalDiagnosis

0..*

EmergencyDepartmentVisitPerformed

Clinical Focus: This set of values identifies procedures representing an emergency department encounter.

Data Element Scope: The intent of this data element is to identify patients who have had an emergency department encounter. Using the Quality Data Model, this particular element will map to the 'Encounter' category.

Inclusion Criteria: Include codes representing an emergency department visit encounter utilizing the SNOMED CT code system.

Exclusion Criteria: None

Subject constrained to the Emergency Department Visit

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

EmergencyDepartmentVisitPerformed

0..*

ComfortMeasuresOrder

Clinical Focus: This set of values contains care regimes used to define comfort measure care.

Data Element Scope: The intent of this data element is to identify patients receiving comfort measures care. Using the Quality Data Model, this particular element would map to the Intervention category.

Inclusion Criteria: Include SNOMEDCT regime and therapy codes for comfort measures, terminal care, dying care, and hospice care.

Exclusion Criteria: None.

Subject constrained to the Comfort Measures

InterventionOrder: Data elements that meet criteria using this datatype should document a request to perform the intervention indicated by the QDM category and its corresponding value set. Timing: The time the order is signed; Author dateTime

DataType

Cardinality

ComfortMeasuresOrder

0..*

ComfortMeasuresPerformed

Clinical Focus: This set of values contains care regimes used to define comfort measure care.

Data Element Scope: The intent of this data element is to identify patients receiving comfort measures care. Using the Quality Data Model, this particular element would map to the Intervention category.

Inclusion Criteria: Include SNOMEDCT regime and therapy codes for comfort measures, terminal care, dying care, and hospice care.

Exclusion Criteria: None.

Subject constrained to the Comfort Measures

InterventionPerformed: Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The time the intervention begins stopTime – The time the intervention ends NOTE - timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.

DataType

Cardinality

ComfortMeasuresPerformed

0..*

AntithromboticTherapyDischarge

Clinical Focus: This set of values contains anticoagulant and antiplatelet drugs used to reduce stroke mortality and morbidity.

Data Element Scope: The intent of this data element is to identify patients who receive antithombotic therapy following stroke. Using the Quality Data Model, this particular element would map to the Medication category.

Inclusion Criteria: Include single and multi-ingredient drugs. Oral, rectal, and injectable dose forms should be included. Antithrombotic medications include anticoagulants and antiplatelet drugs.

Exclusion Criteria: Exclude enoxaparin and heparin codes generally given for VTE prophylaxis.

Subject constrained to the Antithrombotic Therapy

MedicationDischarge: Data elements that meet criteria using this datatype should document that the medications indicated by the QDM category and its corresponding value set should be taken by or given to the patient after being discharged from an inpatient encounter. Timing: The time the discharge medication list on the discharge instruction form is authored.

DataType

Cardinality

AntithromboticTherapyDischarge

0..*

EthnicityPatientCharacteristicEthnicity

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Ethnicity valueset (2.16.840.1.114222.4.11.837)

PatientCharacteristicEthnicity: Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set. Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

DataType

Cardinality

EthnicityPatientCharacteristicEthnicity

0..*

OncAdministrativeSexPatientCharacteristicGender

Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.

Data Element Scope: Gender

Inclusion Criteria: Male and Female only.

Exclusion Criteria: Any gender identity that is not male or female.

ResultValue constrained to codes in the ONC Administrative Sex valueset (2.16.840.1.113762.1.4.1)

PatientCharacteristicGender: Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set. Timing: Birth (administrative) sex does not have a specific timing.

DataType

Cardinality

OncAdministrativeSexPatientCharacteristicGender

0..*

PayerPatientCharacteristicPayer

Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system

Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC

Inclusion Criteria: All codes in the code system

Exclusion Criteria: none

ResultValue constrained to codes in the Payer valueset (2.16.840.1.114222.4.11.3591)

PatientCharacteristicPayer: Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer stopTime – The last day of insurance coverage with the referenced payer

DataType

Cardinality

PayerPatientCharacteristicPayer

0..*

RacePatientCharacteristicRace

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Race valueset (2.16.840.1.114222.4.11.836)

PatientCharacteristicRace: Data elements that meet criteria using this datatype should document the patient’s race. Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

DataType

Cardinality

RacePatientCharacteristicRace

0..*