Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge (NQF 0241)

eMeasure Name Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge (NQF 0241) eMeasure Id 94508E82-D702-4180-8793-31F537CB60FD
Version number 1 eMeasure Set Id Pending
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by None
Description Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke or transient ischemic attack (TIA) with documented permanent, persistent, or paroxysmal atrial fibrillation who were prescribed an anticoagulant at discharge
Copyright
© 2010 American Medical Association and/or National Committee for Quality Assurance. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Patients with atrial fibrillation (permanent, persistent, or paroxysmal) and stroke should be prescribed an anticoagulant to prevent recurrent strokes.
Clinical Recommendation Statement
Administer antithrombotic therapy (oral anticoagulation or aspirin) to all patients with AF, except those with lone AF, to prevent thromboembolism. (ACC/AHA/ESC, 2001). It is recommended that clinicians use long-term oral anticoagulation (target INR of 2.5; range, 2.0 to 3.0) for prevention of stroke in atrial fibrillation patients who have suffered a recent stroke or TIA. Oral anticoagulation is also beneficial for prevention of recurrent stroke in patients with several other high-risk cardiac sources. (ACCP, 2001). For patients with ischemic stroke or TIA with persistent or paroxysmal AF, anticoagulation with adjusted-dose warfarin (target INR, 2.5; range 2.0 to 3.0) is recommended. (ASA, 2006).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
American College of Cardiology, American Heart Association, European Society of Cardiology. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. J Am Coll Cardiol 2001; 38; 1266i-lxx.
Reference
Albers GW, Amarenco P, Easton JD, Sacco RL, and Teal P. Antithrombotic and thrombolytic therapy for ischemic stroke. Chest 2001;119; 300-320.
Reference
Sacco RL, Adams R, Albers G, Alberts MJ, et al. Guidelines for Preventions of Stroke in Patients with Ischemic Stroke or Transient Ischemic Attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke 2006;37:577-617.
Definition
Persistent Atrial Fibrillation: Recurrent atrial fibrillation, not self-terminating or terminated electrically or pharmacologically. 
Paroxysmal Atrial Fibrillation: Recurrent atrial fibrillation, self-terminating.
Permanent Atrial Fibrillation: Long-standing atrial fibrillation (> 1 year), cardioversion failed or not attempted.
Prescribed: May include prescription given to the patient for anticoagulant therapy at discharge or patient already taking anticoagulant therapy as documented in the current medication list.
Definition
Initial Patient Population(s): Patient Age: Patients aged 18 years and older before the start of the measurement period. Diagnosis, Active: Diagnosis of ischemic stroke or TIA. Encounter: Inpatient consultation or inpatient discharge day management.
Definition
Denominator(s): All patients aged 18 years and older with a diagnosis of ischemic stroke or TIA with documented permanent, persistent, or paroxysmal atrial fibrillation.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who were prescribed an anticoagulant at discharge
Definition
Denominator Exception(s): Documentation of medical reason(s) for not prescribing an anticoagulant at discharge.
Documentation of patient reason(s) for not prescribing an anticoagulant at discharge.
Guidance
The measure numerator requires an active medication (oral anti-coagulant) or an order for the medication at the time of discharge. Active medication should be in the Discharge discharge medications listed is present in the discharge summary originating during the hospital discharge.  The same patterns are used as with med order or med active except that a different LOINC code is used for  the status (LOINC 18617-1)
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012