Brief description of measure CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Description of issue ​During AU 2022, it was suggested for the major surgical procedure denominator exclusion to change timing from "21 days or less before end of ED encounter" to "21 days or less before start of ED Encounter" to align with other definitions, guidelines, and more closely following a clinician's thought process since, during ED assessment, they would know the time of the start of the ED encounter but not the end. The major surgical procedure denominator exclusion in this measure was structured as "end of ED encounter" to allow for exclusion of any surgeries that occur during the ED encounter which would be a contraindication for STEMI therapies and to mirror the guidelines as accurately as possible. Based on discussions with clinical experts, the measure developers has decided to revise the exclusion timing to "21 days before start of ED encounter or during the ED encounter" since this would capture the true intent of this exclusion. Goal of review Obtain clinical and technical feedback

Proposed solution ​Change timing of major surgical procedure denominator exclusion to "21 days before start of ED encounter or during the ED encounter" from "21 days or less before End of ED encounter" CURRENT logic: "ED Encounter with STEMI Diagnosis" EDwSTEMI   with ["Procedure, Performed": "Major Surgical Procedure"] MajorSurgery     such that Global."NormalizeInterval" ( MajorSurgery.relevantDatetime, MajorSurgery.relevantPeriod ) starts 21 days or less before     end of EDwSTEMI.relevantPeriod PROPOSED logic: "ED Encounter with STEMI Diagnosis" EDwSTEMI   with ["Procedure, Performed": "Major Surgical Procedure"] MajorSurgery     such that (Global."NormalizeInterval" ( MajorSurgery.relevantDatetime, MajorSurgery.relevantPeriod ) starts 21 days or less before start of EDwSTEMI.relevantPeriod or Global."NormalizeInterval" ( MajorSurgery.relevantDatetime, MajorSurgery.relevantPeriod ) starts during EDwSTEMI.relevantPeriod) Rationale for change The intent of the measure is to exclude patients who have had a major surgical procedure within 21 days prior to the ED encounter and patients who may have had a procedure during the ED encounter. The new definition clarifies this point.