OP-STEMI RelevantPeriod Issue

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Tyler Greguson
    • Mayo Clinic
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Our understanding of the intent of your question is to determine why the measure uses ED Encounter with STEMI diagnosis relevantPeriod attribute times rather than facilityLocation attribute times to identify the denominator exclusion of major surgery within 21 days or less before the start the ED encounter. The major surgery exclusion is measured in a unit of days; therefore, use of relevantPeriod attribution time is precise enough for this measurement. There are other functions within the measure, such as numerator criteria #3: departure with transfer to acute care facility within 45 minutes of ED arrival, that use time stamps based on locationPeriod to precisely measure minutes as a unit of measurement.
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      Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Our understanding of the intent of your question is to determine why the measure uses ED Encounter with STEMI diagnosis relevantPeriod attribute times rather than facilityLocation attribute times to identify the denominator exclusion of major surgery within 21 days or less before the start the ED encounter. The major surgery exclusion is measured in a unit of days; therefore, use of relevantPeriod attribution time is precise enough for this measurement. There are other functions within the measure, such as numerator criteria #3: departure with transfer to acute care facility within 45 minutes of ED arrival, that use time stamps based on locationPeriod to precisely measure minutes as a unit of measurement.
    • CMS0996v4
    • ED relevantPeriod is not able to be configued to facilityLocation attribute times. This creates inaccurate relevantPeriods for the measure evaluation, resulting in inaccurate measure status results and an abnormally high number of denominator exclusions

      Hello,

       

      We’d like to provide some feedback on the STEMI measure regarding the way relevantPeriod is able to be configured.

       

      We recently requested our EHR vendor to change the configuration of the relevantPeriod end date/time to more accurately capture this time-sensitive measure. They informed us that due to the restraints of the measure, they were not able to do this.

       

      They informed us that the STEMI-ED measure does not use facilityLocation attribute times and instead only looks to the "Encounter, Performed: Emergency Visit" relevantPeriod times. This means the relevantPeriod end date/time is limited to using the Patient Class upgrade to inpatient (via our “admit to inpatient” order).

       

      This presents a problem because that order does not accurately represent where the patient actually is. Site workflows differ as to whether this order gets placed prior to, during, or after a PCI procedure.  With the time-sensitive nature of this measure, accurately representing where the patient actually is has a huge impact on the measure results.

       

      Because of this issue, 63% of our cases are being excluded due to many PCIs being considered “Major surgical procedures” because of the inaccurate ED relevantPeriod.  

       

      Ultimately, we feel it would be much more accurate to base the relevantPeriod end date/time on where the patient is in the facility. Please consider updating the measure to allow our EHR vendor the option to use facilityLocation attribubte times to detemine the end date/time of the ED relevantPeriod

       

            Assignee:
            Augustine Weber
            Reporter:
            Tyler Greguson
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