Primary PCI Received Within 90 Minutes of Hospital Arrival (NQF 0163)

eMeasure Name Primary PCI Received Within 90 Minutes of Hospital Arrival eMeasure Id 50BD593F-C0D0-4D75-AAA8-D5EB146C8FE3
Version number 1 eMeasure Set Id 95202FD2-6B92-4900-9059-E6BEF06D89E0
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Endorsed by None
Description Acute myocardial infarction (AMI) patients with ST-segment elevation or LBBB on the ECG closest to arrival time receiving primary PCI during the hospital stay with a time from hospital arrival to PCI of 90 minutes or less.
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
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 (Antman, 2004); Antman, 2008; and Kushner, 2009.
Clinical Recommendation Statement
National guidelines recommend the prompt initiation of PCI in patients presenting with ST-elevation myocardial infarction
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.
Reference
Brodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, et al. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 1998;32-1312-9.
Reference
DeLuca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109(10):1223-1225.
Reference
Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046 –99.
Reference
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;51:210–47.
Reference
Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54:2205– 41.
Definition
Initial Patient Population(s): All hospital discharges for acute myocardial infarction (AMI) with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission with ST-elevation or left bundle branch block (LBBB) on electrocardiogram (ECG) who received primary percutaneous coronary intervention (PCI)
Definition
Denominator(s): AMI patients age 18 and older with ST-elevation or LBBB on ECG who received primary PCI with An ICD-9-CM Principal Diagnosis Code for AMI AND PCI (ICD-9-CM Principal and Other Procedure Codes for PCI) AND ST-segment elevation or LBBB on the ECG performed closest to hospital arrival AND PCI performed within 24 hours after hospital arrival
Definition
Denominator Exclusion(s): Patients enrolled in clinical trials. 
Patients received as a transfer from an inpatient or outpatient department of another hospital. 
Patients received as a transfer from the emergency/observation department of another hospital. 
Patients received as a transfer from an ambulatory surgery center. 
Patients administered fibrinolytic agent prior to PCI 
PCI described as non-primary by a physician/advanced practice nurse/physician assistant (physician/APN/PA). 
Patients who did not receive PCI within 90 minutes and had a reason for delay documented by a physician/APN/PA (e.g., social, religious, initial concern or refusal, cardiopulmonary arrest, balloon pump insertion, respiratory failure requiring intubation).
Definition
Numerator(s): AMI patients whose time from hospital arrival to primary PCI is 90 minutes or less
Definition
Denominator Exception(s): N/A
Guidance
Denominator element guidance:

The denominator and numerator criteria indicate scenarios in which the patient is admitted to the hospital directly (to ICU or Non-ICU locations) or the patient is admitted to one of these locations from the Emergency Department (ED).  The calculation is to indicate the timing from arrival at the facility to the occurrence of an event. The arrival, therefore can be determined from the Emergency Department, the Non-ICU location, or the ICU location, whichever is the first location of contact between the patient and the facility.
			
For the denominator data element "diagnostic test result: ECG," EHR implementations will need to develop mechanisms to capture ECG findings to support denominator criteria for this measure.  The measure specification indicates allowable findings.  It is assumed in the abstraction guidance for this measure that the source of the ECG results is a physician.
			
Numerator element guidance:

This measure expects a PCI procedure within 90 minutes of hospital arrival.  Those patients receiving PCI procedures greater than 90 minutes after arrival may be excluded from the denominator only if there is a documented reason or documented occurrence of endotracheal intubation, cardiopulmonary arrest or intraaortic balloon pump insertion within the first 90 minutes after arrival. Patients receiving PCI procedures greater than 90 minutes after arrival and with no reason provided are not compliant with the numerator criteria and will remain in the denominator.
			
Exclusion element guidance: 

The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for acute myocardial infarction (AMI), ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (non-STEMI) or heart attack, the same conditions as covered by the measure. Other clinical trials are not valid reasons for exclusions. 

Transfers from another hospital or an Emergency Department that is not part of the hospital's organization are excluded since care may have been delivered in the other setting.  The measure as specified for abstraction allowed determination of other hospital or other hospital Emergency Departments by hospital billing number. Transfers within 1 day from those hospitals or Emergency Departments using the same facility number are considered transfers for the exclusion section of this measure. 

PCI procedures analyzed in this measure must be primary procedures. Primary includes emergent or urgent PCI procedures and not those described by the physician/APN/PA anywhere in the record as elective, not emergent, not immediate, not primary, not urgent, or secondary.  From a clinical standpoint, Primary PCI is loosely defined a percutaneous intervention performed in the acute setting in patients with ST segment elevation MI which is intended to restore perfusion in the infarct-related artery. In randomized trials and observational studies, this therapy is associated with significant reductions in the risks of adverse events, including death, in selected patients with STEMI.
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