Core MeasuresAn Overview

October, 2009

What are the Core Measures?

A Standard set of data elements that are…

Based on:• Evidence-based medicine• Large scale scientific studies with proven efficacy

Related to:• Specific diagnoses / medical conditions

• Specific patient care actions and outcomes

•Scientific studies have been incorporated into Scientific studies have been incorporated into guidelines developed by professional guidelines developed by professional organizationsorganizations

•Consensus of national experts panel for each Consensus of national experts panel for each measuremeasure

•Proven to be measurable and reliable Proven to be measurable and reliable measures of the quality of caremeasures of the quality of care

•Focus on clinical processes: all patients, Focus on clinical processes: all patients, without contraindicationswithout contraindications, should be considered , should be considered candidates for therapiescandidates for therapies

Why did CMS develop the Core Measures?

• Topics focus on health problems most common to the Medicare population

• Effective interventions have been shown to reduce disability and save lives

• Based on national data, many Medicare patients do not receive important therapies known to decrease morbidity and mortality

To whom are these measures reported?

• Reported to:

• Government and regulatory agencies

• CMS – Center for Medicare & Medicaid Services

• TJC – The Joint Commission

• The public via websites • hospitalcompare.hhs.gov (CMS site)• qualitycheck.org (TJC site)

Inpatient Core Measure Groups

• Acute Myocardial Infarction (AMI)

• Congestive Heart Failure (HF)

• Pneumonia (PN)

• Surgical Care Improvement Project (SCIP)

• Childhood Asthma Prevention (CAC)

AMI Measures

AMI 1 Aspirin w/in 24 hours of arrival*

The early use of aspirin in patients with acute myocardial infarction results in a significant reduction in adverse events and subsequent mortality

AMI-2 Aspirin at discharge.*

Studies have demonstrated that aspirin can reduce this risk by 20%

AMI Measures

AMI-3 ACEI or ARB for LVSD*

ACEI therapy reduces mortality and morbidity in patients with left ventricular systolic dysfunction (LVSD) after AMI

AMI Measures

AMI- 4 Smoking Cessation Counseling

Smoking cessation reduces mortality and morbidity in all populations. Patients who receive even brief smoking-cessation advice from their care providers are more likely to quit.

Same for

HF-4 and PN-4

AMI Measures

AMI-5 Beta Blocker at discharge*

Beta blockers prescribed for patients who have suffered an acute myocardial infarction can reduce mortality and morbidity.

Studies have demonstrated that the use of beta blockers is associated with about a 20% risk reduction

AMI Measures

AMI-7 Median time to fibrinolysis

AMI-7a Thrombolytic Agent received within 30 minutes of arrival

• Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction.

• Consider that nearly 2 lives per 1000 patients are lost per hour of delay

AMI Measures

AMI-8 Median time to PCI

AMI-8a PCI received within 90 minutes of patient arrival

• The early use of primary angioplasty in patients with acute myocardial infarction who present with ST-segment elevation or LBBB results in a significant reduction in mortality and morbidity

• The earlier primary coronary intervention is provided, the greater its effect

Heart Failure Measures

HF –1 Discharge Instructions

Written instructions or educational material must address all of the following:

• Activity level• Diet• A written list of discharge medications• Follow-up appointment• Weight monitoring• What to do if symptoms worsen

Heart Failure Measures

HF-2 LVF assessment*

The identification of patients with impaired left ventricular systolic function is required in order to treat with appropriate selection of medications to

reduce morbidity and mortality in heart failure

Heart Failure Measures

HF-3 ACEI or ARB for LVSD*

ACEI/ARB therapy reduces mortality and morbidity in patients with heart failure and left

ventricular systolic dysfunction

Pneumonia Measures

PN-2 Pneumococcal vaccination*

Pneumococcal vaccination is indicated for persons 65 years of age and older, because it is up to 75% effective in preventing pneumococcal bacteremia and meningitis.

PN-3a Blood cultures performed w/in 24 hours prior to or after admission to the ICU

PN-3b- Blood cultures preformed in the ED before the initial antibiotic

Published treatment guidelines recommend the collection of blood cultures for all inpatients with

severe pneumonia to optimize therapy

Pneumonia Measures

PN-5c - Initial antibiotic received within 6 hours of Arrival

… clinical evidence of an association between timely inpatient administration of antibiotics and improved outcome among pneumonia patients

Pneumonia Measures

PN-6 Initial antibiotic selection for CAP

-6a ICU patient

-6b Non- ICU patient

• PN-7 • Pneumonia patients age ≥ 50 yo, hospitalized during October, November, December, January, February or March who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated.

Surgical Care Improvement Project Prophylactic Antibiotics

• SCIP-Inf 1 Prophylactic Antibiotics given within one hour of anesthesia start time

• SCIP-Inf 2 Appropriate antibiotic selection

• SCIP-Inf 3 Stopped within 24 hours after anesthesia end time (48 hours for cardiac surgery)

Surgical Care Improvement Project

• SCIP-Inf 4 Controlled 0600 Blood Glucose (Cardiac Surgery Patients only)Several studies have demonstrated a strong relationship between hyperglycemia and surgical site infections.

• SCIP-Inf 6 Appropriate Hair Removal Shaving predisposes to infection by creating tiny cuts and abrasions in

the dermal surface).

• SCIP-Card 2 Perioperative Beta Blocker

Administration

Patients on chronic beta blocker therapy experience an increase in morbidity and mortality if beta blockers are omitted in the perioperative period. ADMRO needs the date and time of last dose taken and communicate this in Hand-off to POHA-CRNA-PACU.

Surgical Care Improvement Project

• SCIP-Inf 9 Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zero.

It is well–established that the risk of catheter-associated urinary tract infection (UTI) increases with increasing duration of indwelling urinary catheterization.

• SCIP-Inf 10 Surgery Patients with Perioperative Temperature Management

For the purpose of maintaining normothermia one body temperature equal to or greater than 96.8° F/36° C recorded within the 30 minutes immediately prior to or the 15 minutes immediately after Anesthesia End Time abstracted. (For PACU/OR only)

Core temperatures outside the normal range pose a risk in all patients undergoing surgery.

Surgical Care Improvement Project

SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered

SCIP-VTE-2 Surgery Patients Who Received Appropriate VTE Prophylaxis Within 24 Hours Prior

to Surgery to 24 Hours After Surgery

Goals:

• Better outcomes for our patients.

• Shorter lengths of stay.

• Fewer complications.

• Improved compliance and reimbursement.

• Being wiser, smarter caregivers.