ecqm.measure

CMS53v7 - Primary PCI Received Within 90 Minutes of Hospital Arrival (AMI-8a)

Rationale:

Primary PCI Received Within 90 Minutes of Hospital Arrival (AMI-8a). The early use of primary angioplasty in patients with ST-segment myocardial infarction (STEMI) results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is (Brodie, 1998 and DeLuca, 2004). National guidelines recommend the prompt initiation of PCI in patients presenting with ST-elevation myocardial infarction (O'Gara, 2013; and Levine 2011).

Data Elements

CardiopulmonaryArrestDiagnosis

Clinical Focus: This set of values contains the diagnosis used to identify patients with a cardiopulmonary arrest.

Data Element Scope: The intent of this data element is to identify patients with a diagnosis of cardiopulmonary arrest. Using the Quality Data Model, this particular element would map to the Principal Diagnosis attribute for the Encounter category.

Inclusion Criteria: Include diagnosis codes that identify cardiac arrest.

Exclusion Criteria: Exclude codes that describe history of cardiac arrest.

ResultValue constrained to codes in the Cardiopulmonary arrest valueset (2.16.840.1.113883.3.666.5.748)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

CardiopulmonaryArrestDiagnosis

0..*

ElectrocardiogramEcgPerformed

Clinical Focus: This value set contains diagnoses and procedures used to define electrocardiogram (ECG).

Data Element Scope: The intent of this data element is to identify patients who receive the diagnostic test electrocardiogram (ECG). Using the Quality Data Model, this particular element would map to the Diagnostic Study category.

Inclusion Criteria: Include codes that identify patients receiving an electrocardiogram (ECG).

Exclusion Criteria: None.

Subject constrained to the Electrocardiogram (ECG)

DiagnosticStudyPerformed: Data elements that meet criteria using this datatype should document the completion of the diagnostic study indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – when the diagnostic study is initiated stopTime – when the diagnostic study is completed Examples: 1) Initiation of a treadmill stress test to the time the treadmill stress test has completed. 2) Initiation of the ultrasound study until completion of the ultrasound study

DataType

Cardinality

ElectrocardiogramEcgPerformed

0..*

EncounterInpatientPerformed

Clinical Focus: This set of values identify the most common inpatient encounter types.

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

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

Exclusion Criteria: None.

Subject constrained to the Encounter Inpatient

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

EncounterInpatientPerformed

0..*

AcuteOrEvolvingMiPrincipalDiagnosis

Clinical Focus: This grouping value set contains diagnoses used to identify patients with an acute or evolving myocardial infarction.

Data Element Scope: The intent of this data element is to identify patients with an acute or evolving myocardial infarction. Using the Quality Data Model, this particular element would map to the Result attribute.

Inclusion Criteria: Include codes that identify patients with an acute myocardial infarction. This is a grouping of ICD10CM and SNOMEDCT 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

AcuteOrEvolvingMiPrincipalDiagnosis

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..*

FibrinolyticTherapyAdministered

Clinical Focus: This set of values contains medications that are prescribed for Fibrinolytic therapy in patients with an episode of acute myocardial infarction.

Data Element Scope: The intent of this data element is to identify patients who are prescribed fibrinolytic therapy during an episode of acute myocardial infarction. Using the Quality Data Model, this particular element would map to the Medication, Administered data type.

Inclusion Criteria: Include generic and prescribable fibrinolytic agents. Injectable dose forms should be included. Single ingredient.

Exclusion Criteria: None.

Subject constrained to the Fibrinolytic Therapy

MedicationAdministered: Data elements that meet criteria using this datatype should document that the medication indicated by the QDM category and its corresponding value set was actually administered to the patient. Timing: The Relevant Period addresses: startTime = when a single medication administration event starts (e.g., the initiation of an intravenous infusion, or administering a pill or IM injection to a patient); stopTime = when a single medication administration event ends (e.g., the end time of the intravenous infusion, or the administration of a pill or IM injection is completed - for pills and IM injections, the start and stop times are the same) NOTE – Measure developers should address multiple administrations over a period of time using CQL logic. Refer to Special Cases in Appendix A (Section A.3) for scenarios to consider in calculating cumulative medication duration.

DataType

Cardinality

FibrinolyticTherapyAdministered

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..*

PciPerformed

Clinical Focus: This grouping value set contains procedures used to define percutaneous coronary intervention (PCI).

Data Element Scope: The intent of this data element is to identify patients who had percutaneous coronary intervention (PCI) during an episode of acute myocardial infarction. Using the Quality Data Model, this particular element would map to the Procedure, Performed datatype.

Inclusion Criteria: Include codes that identify patients receiving percutaneous coronary intervention (PCI). This is a grouping of ICD10PCS and SNOMEDCT codes.

Exclusion Criteria: None

Subject constrained to the PCI

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

PciPerformed

0..*

EndotrachealIntubationPerformed

Clinical Focus: This grouping value set contains procedures used to define endotracheal intubation.

Data Element Scope: The intent of this data element is to identify patients who receive endotracheal intubation as a medical procedure. Using the Quality Data Model, this particular element would map to the Procedure, Performed datatype.

Inclusion Criteria: Include codes that identify patients receiving an endotracheal airway inserted into the trachea. This is a grouping of ICD10PCS and SNOMEDCT codes.

Exclusion Criteria: None

Subject constrained to the Endotracheal Intubation

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

EndotrachealIntubationPerformed

0..*

AorticBalloonPumpInsertionPerformed

Clinical Focus: This set of values contains procedures used to identify aortic balloon pump insertion.

Data Element Scope: The intent of this data element is to identify patients with the procedure aortic balloon pump insertion. Using the Quality Data Model, this particular element would map to the Procedure, Performed data type.

Inclusion Criteria: Include codes that describe insertion of the aortic balloon pump.

Exclusion Criteria: Exclude codes that describe complications and procedures removing the device.

Subject constrained to the Aortic balloon pump insertion

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

AorticBalloonPumpInsertionPerformed

0..*

VentricularAssistDevicePlacementPerformed

Clinical Focus: This grouping value set contains procedures used to identify the placement of a ventricular assist device.

Data Element Scope: The intent of this data element is to identify procedures for ventricular assist device placement. Using the Quality Data Model, this particular element would map to the Procedure, Performed datatype.

Inclusion Criteria: Include codes that identify patients with ventricular assist device placement. This is a grouping of ICD-10-PCS and SNOMEDCT codes.

Exclusion Criteria: None.

Subject constrained to the Ventricular Assist Device placement

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

VentricularAssistDevicePlacementPerformed

0..*