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  2. CQM-2588

Exclude Diagnoses of Hemorrhagic converesions from ischemic stroke measures

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    • Ainsley Chitwood
    • 832=783-1442
    • Houston Methodist Hospital System
    • eCQM specifications for CMS 104, CMS 71, CMS 72 and CMS 105
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      Thank you for your question. For all of the stroke measures, the initial patient population is only looking for patients who have a principal diagnosis of ischemic or hemorrhagic stroke. Then, the denominator for STK-2,3,5, and 6 is further refined to look for patients who have a principal diagnosis of ischemic stroke. In the case that you have a patient who has a principal diagnosis of ischemic stroke AND a secondary diagnosis of hemorrhagic stroke, you would need discrete documentation that supports and is mapped to the "Medical Reason" for not administering the anticoagulant or antithrombotic medication, depending on the measure. Hemorrhage is NOT a contraindication for statin therapy, so for STK-6, those patients should not be excluded from the measure. For more information on the stroke electronic clinical quality measures, please refer to the Pioneers in Quality: Expert to Expert website, which has recorded webinars for all of the stroke measures. The Pioneers in Quality website is located here: https://www.jointcommission.org/piq_expert_to_expert_series/
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      Thank you for your question. For all of the stroke measures, the initial patient population is only looking for patients who have a principal diagnosis of ischemic or hemorrhagic stroke. Then, the denominator for STK-2,3,5, and 6 is further refined to look for patients who have a principal diagnosis of ischemic stroke. In the case that you have a patient who has a principal diagnosis of ischemic stroke AND a secondary diagnosis of hemorrhagic stroke, you would need discrete documentation that supports and is mapped to the "Medical Reason" for not administering the anticoagulant or antithrombotic medication, depending on the measure. Hemorrhage is NOT a contraindication for statin therapy, so for STK-6, those patients should not be excluded from the measure. For more information on the stroke electronic clinical quality measures, please refer to the Pioneers in Quality: Expert to Expert website, which has recorded webinars for all of the stroke measures. The Pioneers in Quality website is located here: https://www.jointcommission.org/piq_expert_to_expert_series/
    • CMS71v6/NQF0436, CMS72v5/NQF0438, CMS104v5/NQF0435, CMS105v5/NQF0439
    • CMS72v3/NQF0438
    • Cleaner reporting

      In the specification for the ischemic stroke related measures, there is no parameter to exclude patients with a secondary diagnosis of hemorrhagic stroke. It seems logical that these cases should be excluded from the measures, as treatment with antithrombotics and anticoagulants and statins seems to be the wrong course for these patients with active bleeds. Please consider adding this exclusion to account for the patients who have a hemorrhagic conversion during the course of their treatment.

      Please add exclusionary criteria to these measures for patients with a secondary diagnosis of Hemorrhagic stroke or bleed. We are finding these patients are being included in the denominators of these measures, but it seems more logical that they be excluded, as treatment with anticoagulants, antithrombotics seems incorrect given the bleed.

            JLeflore Mathematica EH eCQM Team
            wamnamc Ainsley Chitwood (Inactive)
            Ainsley Chitwood (Inactive), DIANE ONEILL (Inactive)
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