Title
Acute myocardial infarction (AMI)/chest pain: percentage of ED patients with AMI or chest pain who received aspirin within 24 hours before ED arrival or prior to transfer.
Source(s)
| Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 5.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2011 Dec. various p. |
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Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure
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Description
This measure is used to assess the percentage of emergency department (ED) patients 18 years and older with acute myocardial infarction (AMI) or chest pain who received aspirin within 24 hours before ED arrival or prior to transfer.
Rationale
The early use of aspirin in patients with acute myocardial infarction (AMI) results in a significant reduction in adverse events and subsequent mortality. The benefits of aspirin therapy on mortality are comparable to fibrinolytic therapy. The combination of aspirin and fibrinolytics provides additive benefits for patients with ST-segment elevation myocardial infarction. Aspirin is also effective in patients with non-ST-segment elevation myocardial infarction. National guidelines strongly recommend early aspirin for patients hospitalized with AMI.
Evidence for Rationale
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2004 Aug 4;44(3):671-719. [207 references] PubMed  |
| Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 5.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2011 Dec. various p. |
| Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, Ho PM, Kosiborod MN, Masoudi FA, Nallamothu BK, American College of Cardiology/American Heart Association Task Force on Performance Measures, American Academy of Family Physicians, American College of Emergency Physicians, American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Cardiovascular Angiography and Interventions, Society of Hospital Medicine. ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction [trunc]. J Am Coll Cardiol 2008 Dec 9;52(24):2046-99. |
| Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988 Aug 13;2(8607):349-60. PubMed |
| Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. The RISC Group. Lancet 1990 Oct 6;336(8719):827-30. PubMed |
| Theroux P, Ouimet H, McCans J, Latour JG, Joly P, Levy G, Pelletier E, Juneau M, Stasiak J, deGuise P, et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med 1988 Oct 27;319(17):1105-11. PubMed |
Primary Health Components
Acute myocardial infarction (AMI); chest pain; angina; acute coronary syndrome; aspirin
Denominator Description
Patients 18 years and older with an emergency department (ED) encounter who were discharged/transferred to a short-term general hospital for inpatient care or to a Federal healthcare facility with a diagnosis of acute myocardial infarction (AMI), or angina, acute coronary syndrome, or chest pain (see the related "Denominator Inclusions/Exclusions" field)
Numerator Description
Emergency department (ED) patients 18 years and older with acute myocardial infarction (AMI) or chest pain (with Probable Cardiac Chest Pain) who received aspirin within 24 hours before ED arrival or prior to transfer (see the related "Numerator Inclusions/Exclusions" field)
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Evidence Supporting the Measure
Type of Evidence Supporting the Criterion of Quality for the Measure
- A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
Extent of Measure Testing
In July 2007, the Oklahoma Foundation for Medical Quality completed a limited pilot test with 80 AMI records in small rural hospitals in Oklahoma and Illinois.
Evidence for Extent of Measure Testing
| Baus K. Personal communication: outpatient measures. 2012 Aug 2. |
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State of Use of the Measure
State of Use
Current routine use
Current Use
External oversight/Medicare
Internal quality improvement
Pay-for-reporting
Public reporting
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Application of the Measure in its Current Use
Measurement Setting
Hospitals
Professionals Involved in Delivery of Health Services
Does not apply to this measure (e.g., measure is not provider specific)
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Specified
Target Population Age
Age greater than or equal to 18 years
Target Population Gender
Either male or female
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National Strategy for Quality Improvement in Health Care
National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Prevention and Treatment of Leading Causes of Mortality
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Institute of Medicine (IOM) National Health Care Quality Report Categories
IOM Care Need
Getting Better
IOM Domain
Effectiveness
Timeliness
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Data Collection for the Measure
Case Finding Period
Encounter Dates: January 1 through June 30 and July 1 through December 31
Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Clinical Condition
Encounter
Institutionalization
Patient/Individual (Consumer) Characteristic
Denominator Time Window
Time window follows index event
Denominator Inclusions/Exclusions
Inclusions
- An E/M Code for emergency department (ED) encounter as defined in Appendix A, Table 1.0*, and
- Patients discharged/transferred to a short-term general hospital for inpatient care, or to a Federal healthcare facility, and
- An International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Diagnosis Code for acute myocardial infarction (AMI) as defined in Appendix A, OP Table 1.1* or an ICD-9-CM Principal or Other Diagnosis Codes for angina, acute coronary syndrome, or chest pain as defined in Appendix A, OP Table 1.1a with Probable Cardiac Chest Pain as defined in the Data Dictionary*
Exclusions
- Patients less than 18 years of age
- Patients with a documented Reason for No Aspirin on Arrival as defined in the Data Dictionary*
*Refer to the original measure documentation for details.
Exclusions/Exceptions
Medical factors addressed
Numerator Inclusions/Exclusions
Inclusions
Emergency department (ED) patients 18 years and older with acute myocardial infarction (AMI) or chest pain (with Probable Cardiac Chest Pain as defined in the Data Dictionary*) who received aspirin within 24 hours before ED arrival or prior to transfer
*Refer to the original measure documentation for details.
Exclusions
None
Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure
An electronic data collection tool is made available from vendors or facilities can download the free CART tool. Paper tools for manual abstraction are also available for the CART tool. These tools are posted on www.QualityNet.org .
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Computation of the Measure
Measure Specifies Disaggregation
Does not apply to this measure
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
External comparison at a point in, or interval of, time
External comparison of time trends
Internal time comparison
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Original Title
OP-4: hospital outpatient acute myocardial infarction and hospital outpatient chest pain: aspirin at arrival.
Submitter
Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]
Developer
Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]
Oklahoma Foundation for Medical Quality - Health Care Quality Collaboration
Funding Source(s)
United States Department of Health and Human Services
Composition of the Group that Developed the Measure
Centers for Medicare & Medicaid Services (CMS) Contractor
Oklahoma Foundation for Medical Quality -- Contractor
Financial Disclosures/Other Potential Conflicts of Interest
Endorser
National Quality Forum
Measure Initiative(s)
Hospital Compare
Hospital Outpatient Quality Reporting Program
Adaptation
This measure was not adapted from another source.
Date of Most Current Version in NQMC
2011 Dec
Date of Next Anticipated Revision
Measure Status
This is the current release of the measure.
This measure updates a previous version: Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 2.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2009. 245 p.
Source(s)
| Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 5.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2011 Dec. various p. |
Measure Availability
The individual measure, "OP-4: Hospital Outpatient Acute Myocardial Infarction and Hospital Outpatient Chest Pain: Aspirin at Arrival," is published in the "Hospital Outpatient Quality Reporting (OQR) Specifications Manual (Version 5.1a)." This document is available from the QualityNet Web site . Check the QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.
NQMC Status
This NQMC summary was completed by ECRI Institute on February 20, 2009. The information was verified by the measure developer on May 8, 2009. This NQMC summary was retrofitted into the new template on May 20, 2011. This NQMC summary was updated by ECRI Institute on June 19, 2012. The information was verified by the measure developer on August 2, 2012.
Copyright Statement
No copyright restrictions apply.
The Hospital Outpatient Quality Reporting (OQR) Specifications Manual (Version 5.1a) is periodically updated by the Centers for Medicare & Medicaid Services. Users of the Hospital OQR Specifications Manual must update their software and associated documentation based on the published manual production timelines.
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