ecqm.measure

CMS107v7 - Stroke Education (STK-08)

Rationale:

Stroke Education (STK-08). There are many examples of how patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. The type of stroke experienced and the resulting outcomes will play a large role in determining not only the course of treatment but also what education will be required. Patient education should include information about the event (eg, cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient's prognosis and potential for rehabilitation.

Data Elements

WrittenInformationGivenCommunicationFromProviderToPatient

Clinical Focus: This set of values contains qualifiers used to represent patients who receive written information.

Data Element Scope: The intent of this data element is to identify patients who receive written information. Using the Quality Data Model, this particular element will map to the 'Communication' category.

Inclusion Criteria: Only SNOMED CT codes representing written information given should be included.

Exclusion Criteria: None

ObservableCode constrained to codes in the Written Information Given valueset (2.16.840.1.113883.3.117.1.7.1.415)

CommunicationFromProviderToPatient: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a provider to a patient. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

WrittenInformationGivenCommunicationFromProviderToPatient

0..*

ActivationOfEmergencyMedicalSystemEducationCommunicationFromProviderToPatient

Clinical Focus: This set of values contains procedures used to represent patients who receives emergency medical system education.

Data Element Scope: The intent of this data element is to identify patients who receive education on the activation of emergency medical system. Using the Quality Data Model, this particular element will map to the 'Communication' category.

Inclusion Criteria: Only SNOMED CT codes representing emergency medical system education should be included.

Exclusion Criteria: None

ObservableCode constrained to codes in the Activation of Emergency Medical System Education valueset (2.16.840.1.113883.3.117.1.7.1.377)

CommunicationFromProviderToPatient: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a provider to a patient. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

ActivationOfEmergencyMedicalSystemEducationCommunicationFromProviderToPatient

0..*

InstructionsForFollowUpAfterDischargeCommunicationFromProviderToPatient

Clinical Focus: This set of values is used to represent patients who receive instructions for follow up care after discharge or follow up care planned and scheduled.

Data Element Scope: The intent of this data element is to identify patients who receive instructions for follow up after discharge or have follow up plans scheduled. Using the Quality Data Model, this particular element will map to the 'Communication' category.

Inclusion Criteria: Only SNOMED CT codes representing instructions for follow up after discharge or follow up care planned and scheduled should be included.

Exclusion Criteria: Exclude codes that do not meet the inclusion criteria.

ObservableCode constrained to codes in the Instructions for Follow Up After Discharge valueset (2.16.840.1.113883.3.117.1.7.1.378)

CommunicationFromProviderToPatient: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a provider to a patient. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

InstructionsForFollowUpAfterDischargeCommunicationFromProviderToPatient

0..*

PrescribedMedicationsEducationCommunicationFromProviderToPatient

Clinical Focus: This set of values contains procedures used to represent patients who receive prescribed medications education.

Data Element Scope: The intent of this data element is to identify patients who receive education on the medications they were prescribed to take. Using the Quality Data Model, this particular element will map to the 'Communication' category.

Inclusion Criteria: Only SNOMED CT codes representing prescribed medications education should be included.

Exclusion Criteria: None

ObservableCode constrained to codes in the Prescribed Medications Education valueset (2.16.840.1.113883.3.117.1.7.1.379)

CommunicationFromProviderToPatient: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a provider to a patient. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

PrescribedMedicationsEducationCommunicationFromProviderToPatient

0..*

RiskFactorsEducationCommunicationFromProviderToPatient

Clinical Focus: This set of values contains procedures used to represent patients who receive risk factor education.

Data Element Scope: The intent of this data element is to identify patients who receive education on risk factors. Using the Quality Data Model, this particular element will map to the 'Communication' category.

Inclusion Criteria: Only SNOMED CT codes representing risk factor education should be included.

Exclusion Criteria: None

ObservableCode constrained to codes in the Risk Factors Education valueset (2.16.840.1.113883.3.117.1.7.1.380)

CommunicationFromProviderToPatient: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a provider to a patient. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

RiskFactorsEducationCommunicationFromProviderToPatient

0..*

WarningSignsAndSymptomsEducationCommunicationFromProviderToPatient

Clinical Focus: This set of values contains procedures used to represent patients who receive warning signs and symptoms education.

Data Element Scope: The intent of this data element is to identify patients who receive education on stroke warnings signs and symptoms. Using the Quality Data Model, this particular element will map to the 'Communication' category.

Inclusion Criteria: Only SNOMED CT codes representing education on warning signs and symptoms should be included.

Exclusion Criteria: None

ObservableCode constrained to codes in the Warning Signs and Symptoms Education valueset (2.16.840.1.113883.3.117.1.7.1.381)

CommunicationFromProviderToPatient: To meet criteria using this datatype, the communication indicated by the Communication QDM category and its corresponding value set must be communicated from a provider to a patient. Timing: The time the communication occurs, or is sent; Author dateTime.

DataType

Cardinality

WarningSignsAndSymptomsEducationCommunicationFromProviderToPatient

0..*

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..*

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..*