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  2. CQM-5453

Questions on history of Afib and anticoag orders for STK 3

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    • Chris Ford
    • 4192283335 2580
    • Lima memorial health system
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      ​Thank you for your questions on CMS71 (eSTK-3), Anticoagulation Therapy for Atrial Fibrillation/Flutter. Yes, a history of Afib, documented on a previous visit, is considered applicable to the visit in the scenario you described. eSTK-3 logic checks whether the Atrial Fibrillation/Flutter diagnosis prevalence period start time occurred on or before the Ischemic Stroke relevant period.

      There is no time limit on the Afib/flutter diagnosis in eSTK-3. Clinically speaking, once patients have Afib/flutter(AF) they are always at risk. The nature of the arrhythmia is that it comes and goes, i.e., “paroxysmal”. It can also be persistent/permanent. We do not know if patients are at greater risk for short runs of AF (<30 sec) or longer. Even with patients that have ablation procedures, it is not uncommon for AF to return.

      Some of ways that patients may be excluded from eSTK-3 are listed below:
      - Inpatient hospitalizations for patients admitted for elective carotid intervention are not included in this measure. This exclusion is implicitly modeled by only including non-elective hospitalizations.
      - Patients with a documented reason for not prescribing anticoagulation therapy at discharge including “Medical Reason” or “Patient Refusal”.

      Please let us know if you have additional questions.
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      ​Thank you for your questions on CMS71 (eSTK-3), Anticoagulation Therapy for Atrial Fibrillation/Flutter. Yes, a history of Afib, documented on a previous visit, is considered applicable to the visit in the scenario you described. eSTK-3 logic checks whether the Atrial Fibrillation/Flutter diagnosis prevalence period start time occurred on or before the Ischemic Stroke relevant period. There is no time limit on the Afib/flutter diagnosis in eSTK-3. Clinically speaking, once patients have Afib/flutter(AF) they are always at risk. The nature of the arrhythmia is that it comes and goes, i.e., “paroxysmal”. It can also be persistent/permanent. We do not know if patients are at greater risk for short runs of AF (<30 sec) or longer. Even with patients that have ablation procedures, it is not uncommon for AF to return. Some of ways that patients may be excluded from eSTK-3 are listed below: - Inpatient hospitalizations for patients admitted for elective carotid intervention are not included in this measure. This exclusion is implicitly modeled by only including non-elective hospitalizations. - Patients with a documented reason for not prescribing anticoagulation therapy at discharge including “Medical Reason” or “Patient Refusal”. Please let us know if you have additional questions.
    • Accurate Abstraction/ Accurate Results

      For STK 3 eCQM - is a history of Afib- documented on a previous visit considered applicable to the visit in question.  for example: Patient comes in in 4/2020 - ekg shows afib.  treated and discharged home follows up with outpatient cardiology.  2 years later patient returns to hospital with stroke symptoms.  Stroke is diagnosed, patient is not in Afib, does not report a history of afib, is not on any anticoags at home for afib.  No documentation during the 2022 visit shows afib. Is the provider expected to pull the old chart information and either ordcer anticoags or chart the reason for not ordering? 

            JLeflore Joelencia Leflore
            Cford Christina Ford (Inactive)
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