Initial Antibiotic Received Within 6 Hours of Hospital Arrival (NQF 0151)

eMeasure Name Initial Antibiotic Received Within 6 Hours of Hospital Arrival eMeasure Id 862B5356-F878-4401-AD88-4C768CFDDB64
Version number 1 eMeasure Set Id 821A9FD8-1C0B-4B95-AB73-2F86832BAFA6
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Endorsed by National Quality Forum
Description Pneumonia patients who receive their first dose of antibiotics within 6 hours after arrival at the hospital
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Time to first antibiotic dose for pneumonia has recently received significant attention from a quality-of care perspective. This emphasis is based on 2 large retrospective studies of Medicare beneficiaries that demonstrated statistically significantly lower mortality among patients who received early antibiotic therapy (Meehan, Houck). The initial study by Meehan demonstrated a 15% relative reduction in 30-day mortality when antibiotics were administered within 8 hours of arrival, whereas the subsequent analysis by Houck et al found that delivery of antibiotics within 4 hours was associated with lower 30-day mortality (15% relative reduction). The studies differed in that Houck and colleagues excluded patients who were on antibiotics prior to hospital arrival. Several small prospective studies that document the time to first antibiotic dose do not consistently demonstrate this reduction in 30-day mortality, although none had as large a patient population as those in the studies of Meehan and Houck. The IDSA/ATS guideline committee did recommend that antibiotic therapy should be administered as soon as possible after the diagnosis of pneumonia is considered likely and specifically state that delivery of first antibiotic dose would be expected within 6–8 hours of presentation whenever the admission diagnosis is likely pneumonia.
Clinical Recommendation Statement
The IDSA/ATS guideline committee recommends that antibiotic therapy should be administered as soon as possible after the diagnosis of pneumonia is considered likely and specifically state that delivery of first antibiotic dose would be expected within 6–8 hours of presentation whenever the admission diagnosis is likely pneumonia.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Bratzler, DW, Houck PM, Nsa W, et al. Initial processes of care and outcomes in elderly patients with pneumonia. {abstract} American College of Emergency Physicians Research Forum, October 15, 2001, Chicago, IL.
Reference
Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, Mabry LR, Musher DM, Plouffle JF, Rakowsky A, Schuchat A, Whitney C and the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group, "Management of Community-Acquired Pneumonia in the Era of Pneumococcal Resistance: A Report From the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group." Arch Intern Med, 160:1399-1408, May 22, 2000.
Reference
Houck PM, Bratzler DW, Nsa W, et al. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164: 637-644.
Reference
Khan KL, Rogers WH, Rubenstein LV, et al. Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. JAMA. 1990:264:1969-1973.
Reference
Mandell LA, Wunderink RG, Anzueta A, Bartlett JG, Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 March 1;44 Suppl 2:S27-72.
Reference
McGarvey RN, Harper JJ. Pneumonia mortality reduction and quality improvement in a community hospital. Qual Rev Bull. 1993;19:124-130.
Reference
Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process and outcomes in elderly patients with pneumonia. JAMA. 1997;278:2080-2084.
Definition
Initial Patient Population(s): All hospital discharges for pneumonia with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission.
Definition
Denominator(s): Pneumonia patients 18 years of age and older with An ICD-9-CM Principal Diagnosis Code of pneumonia OR 
ICD-9-CM Principal Diagnosis Code of septicemia or respiratory failure (acute or chronic) AND An ICD-9-CM Other Diagnosis Code of pneumonia, and abnormal findings on chest x-ray or CT scan of the chest within 24 hours prior to hospital arrival or during the hospitalization.
Definition
Denominator Exclusion(s): Patients with Cystic Fibrosis. 
Patients with Comfort Measures Only documented on day of or day after arrival.
Patients enrolled in clinical trials.
Patients received as a transfer from the emergency/observation department of another hospital.
Patients received as a transfer from an inpatient or outpatient department of another hospital.
Patients received as a transfer from an ambulatory surgery center.
Patients who had no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression.
Patients with Diagnostic Uncertainty.
Patients discharged to another hospital on day of or day after arrival.
Patients who left against medical advice on day of or day after arrival.
Patients who expired on day of or day after arrival.
Patients who do not receive any antibiotics within 24 hours after arrival or who received antibiotics the day of arrival (prior to arrival to the hospital) or the day prior to arrival.
Definition
Numerator(s): Number of pneumonia patients who received their first antibiotic dose within a specified timeframe from hospital arrival.
Definition
Denominator Exception(s): N/A
Guidance
The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec. Patients for whom there are missing or inaccurate data (e.g., arrival time, medication administration, etc.) are considered to have failed the measure; the total number of patients with missing or erroneous (e.g., a time of 03:69 or a date of 10/26/2035) data (i.e., measure failures) must be reported with the results of the measure. 

General Guidance:

The measure 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. 

Exclusion element guidance:

The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for pneumonia, the same condition 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 not considered transfers for the exclusion section of this measure, those using other facility numbers are considered exclusions. 
It is assumed that all patients in observation who are admitted have the admission time retroactively set at the initiation time of observation. Patients admitted to observation and discharged home from observation are not included in this measure.
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