Aspirin at Arrival (NQF 0132)

eMeasure Name Aspirin at Arrival eMeasure Id DDCE906A-7BD7-4BE7-A7A1-09A57C8273E6
Version number 1 eMeasure Set Id FC8F5F88-D124-4B27-82D8-02FF7293C03B
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 Acute myocardial infarction (AMI) patients who received aspirin within 24 hours before or after hospital arrival
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
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-elevation myocardial infarction (ISIS-2, 1988). Aspirin is also effective in patients with non-ST-elevation myocardial infarction (Theroux, 1988 and RISC Group, 1990). National guidelines strongly recommend early aspirin for patients hospitalized with AMI (Antman, 2004; Antman, 2008; and Anderson, 2007).
Clinical Recommendation Statement
The early use of aspirin in patients with acute myocardial infarction results in a significant reduction in adverse events and subsequent mortality.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1–157.
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
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
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
Randomized 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.
Reference
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;336(8719):827-830.
Reference
Theroux P, Ouimet H, McCans J et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988;319(17):1105-1111.
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
Definition
Denominator(s): All Acute Myocardial Infarctions MI patients age 18 and older with an ICD-9-CM Principal Diagnosis Code for Acute Myocardial Infarction
Definition
Denominator Exclusion(s): Patients with Comfort Measures Only documented on day of or day after arrival. Patients enrolled in clinical trials. Patients discharged on day of arrival.
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 with a documented Reason for No Aspirin on Arrival
Definition
Numerator(s): Acute Myocardial Infarction patients who received aspirin within 24 hours before or after 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.

Numerator element guidance: 

The options in the numerator for aspirin administered or active are based on hospital arrival time for all patients directly admitted to the hospital OR are based on Emergency Department arrival time for all patients admitted from the Emergency Department.

Medication administered can account for the patient self administering aspirin as a home medication or for medication that was administered by an EMT and that the patient received the aspirin within the 24 hours immediately prior to the Emergency Department arrival.

Exclusion element guidance: 

Transfers to another hospital 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 by hospital unique identifier. Transfers to those hospitals are considered exclusions regardless of whether the receiving hospital has the same or different hospital unique identifier as the transferring hospital.

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.

Medical or patient reasons for not performing a test or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision.
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