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  2. CQM-4633

Stroke - Medications proposed to be continued during encounter transfer

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      Thank you for your inquiry STK-2, STK-3, STK-6, and CMS506v3. These measures are episode-based measures. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

      Each of these measures use the "Medication, Discharge" datatype, which refers to the discharge medication list and is intended to express medications ordered for post-discharge use. Per the QDM version 5.5 Guidance Update for CQL May 2020 (https://ecqi.healthit.gov/sites/default/files/QDM-v5.5-Guidance-Update-May-2020-508.pdf) pg. 43: Data elements that meet criteria using “Medication Discharge” “should document that the medications indicated by the QDM category and its corresponding value set should be taken by or given to the patient after being discharged from an inpatient encounter… Timing: The time the discharge medication list on the discharge instruction form is authored. The list of medications a patient should take after hospital discharge may come from multiple sources.”

      These measures are specifically assessing for the authorDateTime of medications discharged per episode. Thus, the measure outcomes for an encounter E1 would not be affected by a decision made in a subsequent encounter E2 to modify or to not accept the medication.​
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      Thank you for your inquiry STK-2, STK-3, STK-6, and CMS506v3. These measures are episode-based measures. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. Each of these measures use the "Medication, Discharge" datatype, which refers to the discharge medication list and is intended to express medications ordered for post-discharge use. Per the QDM version 5.5 Guidance Update for CQL May 2020 ( https://ecqi.healthit.gov/sites/default/files/QDM-v5.5-Guidance-Update-May-2020-508.pdf ) pg. 43: Data elements that meet criteria using “Medication Discharge” “should document that the medications indicated by the QDM category and its corresponding value set should be taken by or given to the patient after being discharged from an inpatient encounter… Timing: The time the discharge medication list on the discharge instruction form is authored. The list of medications a patient should take after hospital discharge may come from multiple sources.” These measures are specifically assessing for the authorDateTime of medications discharged per episode. Thus, the measure outcomes for an encounter E1 would not be affected by a decision made in a subsequent encounter E2 to modify or to not accept the medication.​
    • CMS0071v11, CMS0104v10, CMS0105v10, CMS0506v4

      We are looking for guidance about cross-encounter medication reconciliation in the same EMR and the evaluation for the STK-2, 3, 6, Safe Use of Opioids numerator

      Example: A patient Inpatient encounter (E1) qualifies for Stroke measure, he/she is getting transferred to a Rehab facility (under a different encounter (E2), same EHR system). Patient is receiving statin medication as inpatient. During the transfer process (from inpatient to rehab), the clinician in the inpatient facility orders to continue the statin medication in the Rehab facility. The receiving clinician in the rehab facility decides ‘Do not accept’ the statin order or maybe modify the proposed statin order. When evaluating medication that were prescribed or continued at discharge for STK-2, 3, 6, Safe Use of Opioids numerator, should the order ‘proposed’ to be continued by the Inpatient clinician count for E1? Even if it was not accepted or modified later by the Rehab facility clinician (E2)?

      Your guidance would be greatly appreciated

            JLeflore Mathematica EH eCQM Team
            isbelia Isbelia Briceno
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