Clarification needed on OP STEMI LocationPeriod.stopTime

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
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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). The measure captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. Logic for the measure’s third numerator criteria – discharge to PCI-capable acute care within 45 minutes of ED arrival – can be found in the definition below from the measure’s HTML file posted on the eCQI Resource Center [https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html].

      ED Departure With Discharge To Acute Care Facility Within 45 Minutes Of Arrival

        "ED Encounter With STEMI Diagnosis" EDwSTEMI

          with ( Global."HospitalDepartureTime" ( EDwSTEMI ) ) Departure

            such that Departure 45 minutes or less after Global."EmergencyDepartmentArrivalTime" (EDwSTEMI )

              and EDwSTEMI.dischargeDisposition in "Discharge To Acute Care Facility"

      The inquiry in CQM-7490 specifically asked what the measure uses to signal a transfer to acute care. We responded that the measure uses an ED discharge disposition of “Discharge to Acute Care Facility” to signal this transfer, which was specific to the question asked. If a secondary question is being asked regarding the global common functions for ED arrival and ED departure time, used to calculate the third numerator criteria, we agree that these functions do utilize the locationPeriod and facilityLocation attributes.
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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). The measure captures three potential numerators for ED encounters with a STEMI diagnosis: PCI procedure within 90 minutes of ED arrival, fibrinolytic therapy within 30 minutes of ED arrival, or discharge to PCI-capable acute care within 45 minutes of ED arrival. Logic for the measure’s third numerator criteria – discharge to PCI-capable acute care within 45 minutes of ED arrival – can be found in the definition below from the measure’s HTML file posted on the eCQI Resource Center [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ]. ED Departure With Discharge To Acute Care Facility Within 45 Minutes Of Arrival   "ED Encounter With STEMI Diagnosis" EDwSTEMI     with ( Global."HospitalDepartureTime" ( EDwSTEMI ) ) Departure       such that Departure 45 minutes or less after Global."EmergencyDepartmentArrivalTime" (EDwSTEMI )         and EDwSTEMI.dischargeDisposition in "Discharge To Acute Care Facility" The inquiry in CQM-7490 specifically asked what the measure uses to signal a transfer to acute care. We responded that the measure uses an ED discharge disposition of “Discharge to Acute Care Facility” to signal this transfer, which was specific to the question asked. If a secondary question is being asked regarding the global common functions for ED arrival and ED departure time, used to calculate the third numerator criteria, we agree that these functions do utilize the locationPeriod and facilityLocation attributes.
    • CMS0996v6
    • CMS0996v5
    • CQM guidance does not adhere to measure specifications

      The guidance provided in CQM-7490 states that the measure calculation does not use the physical location of the patient. This is not accurate.

      One of the Numerator statements is for "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival." The global function Global.HospitalDepartureTime specifically returns the facilityLocations.locationPeriod.stopTime from the "end of locationPeriod".

      ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival
      "ED Encounter with STEMI Diagnosis" EDwSTEMI
  with ( Global."HospitalDepartureTime" ( EDwSTEMI ) ) Departure
    such that Departure 45 minutes or less after Global."EmergencyDepartmentArrivalTime" ( EDwSTEMI )
      and EDwSTEMI.dischargeDisposition in "Discharge To Acute Care Facility"
      Global.HospitalDepartureTime(Encounter "Encounter, Performed")
      end of Last(("HospitalizationLocations"(Encounter))HospitalLocation
		sort by start of locationPeriod
).locationPeriod
      Global.HospitalizationLocations(Encounter "Encounter, Performed")
      Encounter Visit
	let EDVisit: Last(["Encounter, Performed": "Emergency Department Visit"] LastED
			where LastED.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
			sort by 
			end of relevantPeriod
	)
	return if EDVisit is null then Visit.facilityLocations 
		else flatten { EDVisit.facilityLocations, Visit.facilityLocations }

      The locationPeriod subattribute represents the period of time during which a patient was in the specific facility location. Each Encounter can have many facilityLocations, each with their own code indicating the type of facility, and a locationPeriod representing the arrival and departure from that facility location.

      The location of the patient does have an impact for "ED Departure with Transfer to Acute Care Facility Within 45 Minutes of Arrival" and the guidance in CQM-7490 should be revised.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Alex Liu
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