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  1. eCQM Issue Tracker
  2. CQM-7465

Please clarify timing of the timing parameters for the numerator populations and measure population criteria.

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    • Icon: OQR eCQMs - Outpatient Quality Reporting OQR eCQMs - Outpatient Quality Reporting
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      Thank you for your inquiry regarding Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) (CMS0996v4). We are responding to each scenario below.

      For the first scenario, we want to clarify that the measure does not capture the time from ED arrival at the original facility to PCI procedure in another facility. This measure captures the percentage of ED encounters for patients 18 years and older with a diagnosis of STEMI who received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, PCI 90 minutes of ED arrival, or transfer to Acute Care Facility within 45 minutes of ED arrival. In this scenario, this case would be included in the measure’s denominator for both the original and receiving facilities, assuming none of the measure exclusion criteria apply. For the original facility, the case would meet the numerator criteria if the patient received fibrinolytic therapy within 30 minutes of ED arrival or was transferred within 45 minutes. For the receiving facility, the case would meet the numerator criteria if the patient received the PCI procedure within 90 minutes or received fibrinolytic therapy within 30 minutes of ED arrival.

      For the second scenario, our understanding is that the patient received fibrinolytic therapy in the original ED, and then was transferred to another ED for the PCI procedure. In this scenario, the patient would be included in the measure population for the receiving ED. The issue of a patient receiving fibrinolytic therapy within 24 hours of ED arrival has previously been brought to CMS and measure developer’s attention. The measure developer will consider refinements (i.e. a denominator exception) in a future annual update.
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      Thank you for your inquiry regarding Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) (CMS0996v4). We are responding to each scenario below. For the first scenario, we want to clarify that the measure does not capture the time from ED arrival at the original facility to PCI procedure in another facility. This measure captures the percentage of ED encounters for patients 18 years and older with a diagnosis of STEMI who received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, PCI 90 minutes of ED arrival, or transfer to Acute Care Facility within 45 minutes of ED arrival. In this scenario, this case would be included in the measure’s denominator for both the original and receiving facilities, assuming none of the measure exclusion criteria apply. For the original facility, the case would meet the numerator criteria if the patient received fibrinolytic therapy within 30 minutes of ED arrival or was transferred within 45 minutes. For the receiving facility, the case would meet the numerator criteria if the patient received the PCI procedure within 90 minutes or received fibrinolytic therapy within 30 minutes of ED arrival. For the second scenario, our understanding is that the patient received fibrinolytic therapy in the original ED, and then was transferred to another ED for the PCI procedure. In this scenario, the patient would be included in the measure population for the receiving ED. The issue of a patient receiving fibrinolytic therapy within 24 hours of ED arrival has previously been brought to CMS and measure developer’s attention. The measure developer will consider refinements (i.e. a denominator exception) in a future annual update.
    • CMS0996v5
    • CMS0996v4
    • We are having patients that I feel are inappropriately meeting the measure population due to incorrect capture of start and end times. This is significantly negatively impacting our measure performance.

      Scenario 1:

      For STEMI patients transferred to an acute care facility within 45 minutes of ED arrival, our vendor report calculates the time to PCI at the PCI center using the ED arrival time at the original (outlying) facility until the first device is deployed in the cardiac catheterization lab.  Is the intent of this measure calculation intended to capture the span of time of first medical contact in the emergency room (at the original hospital) until the beginning of coronary intervention of the infarct related vessel at the PCI capable hospital?

       

      Scenario 2:

      When a patient from an outside hospital ED received a thrombolytic and is transferred to an acute care hospital ED with PCI capabilities, should this patient be included in the measure population for the accepting PCI capable hospital. This question is specific to ED to ED transfers.  Often, when the patient arrives at the PCI center after receiving thrombolytic therapy, the patient arrives without chest pain, is hemodynamically stable, and is not taken immediately to the cath lab since safer to wait for the thrombolytic to be metabolized before going for an invasive procedure (PCI).  Since these patients are transferred because of the STEMI presentation at the original ED, the patient has a STEMI diagnosis documented in the PCI capable hospital during the ED encounter.

            aweber Mathematica EH eCQM Team
            SterlyMI Michael Sterly
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