Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival (NQF 0164)

EMeasure Name Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival EMeasure Id 125D93C4-0649-437F-882C-4468D1CD56BA
Version number 1 Set Id 20989970-D86A-446E-BE92-EC4B1612F19F
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 with ST-segment elevation or LBBB on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. Nearly 2 lives per 1000 patients are lost per hour of delay (Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-elevation myocardial infarction (Antman, 2004).
Clinical Recommendation Statement
National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients 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
Fibrinolytic Therapy Trialists (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet. 1994;343:311-22.
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.
Definition
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. 
	
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. 

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 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 using the same hospital unique identifier are not considered transfers for the exclusion section of this measure, those using other facility numbers are considered exclusions. 

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012