OP-40 STEMI Readmission

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Connie Owen
    • 601-479-8125
    • Baptist Memorial Health Care Corporation
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      Thank you for your feedback regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). CMS and the measure developer will consider potential measure refinements for future annual updates.

      Please note that, to differentiate between active and historic STEMI diagnoses in the problem list, it’s important for both the onset and abatement times to be populated in the EHR and mapped to the appropriate QDM data elements to avoid misattribution.

      Since the QDM does not prescribe the source of diagnosis data in the EHR, STEMI diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. A patient with a STEMI diagnosis may be captured in the measure in two ways, as indicated by the measure logic definition below found in 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].

      First, a STEMI diagnosis can be pulled directly from the ED encounter if a STEMI diagnosis was coded during the encounter. Second, the patient can have a diagnosis pulled from a claim, problem list, or other source in the EHR as long as the prevalencePeriod of the STEMI diagnosis started during the ED encounter relevantPeriod. PrevalencePeriod is an attribute of the “Diagnosis” datatype and signifies the onset dateTime to abatement dateTime of the STEMI diagnosis. RelevantPeriod is an attribute of the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” datatype and signifies the startTime that the encounter began (admission time) to the stopTime that the encounter ended (discharge time).
      Show
      Thank you for your feedback regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). CMS and the measure developer will consider potential measure refinements for future annual updates. Please note that, to differentiate between active and historic STEMI diagnoses in the problem list, it’s important for both the onset and abatement times to be populated in the EHR and mapped to the appropriate QDM data elements to avoid misattribution. Since the QDM does not prescribe the source of diagnosis data in the EHR, STEMI diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. A patient with a STEMI diagnosis may be captured in the measure in two ways, as indicated by the measure logic definition below found in 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 ]. First, a STEMI diagnosis can be pulled directly from the ED encounter if a STEMI diagnosis was coded during the encounter. Second, the patient can have a diagnosis pulled from a claim, problem list, or other source in the EHR as long as the prevalencePeriod of the STEMI diagnosis started during the ED encounter relevantPeriod. PrevalencePeriod is an attribute of the “Diagnosis” datatype and signifies the onset dateTime to abatement dateTime of the STEMI diagnosis. RelevantPeriod is an attribute of the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” datatype and signifies the startTime that the encounter began (admission time) to the stopTime that the encounter ended (discharge time).
    • CMS0996v5
    • A patient is included in the STEMI population inappropriately causing the encounter to fail the measure. This could also create a mismatch should we undergo validation.

      Patient directly admitted to cath lab on 12/10 with STEMI and stent placement. On 12/17 the patient returned to the ED complaining of chest pain. The patient was monitored overnight and cathed the next day. The cath was clear so no intervention was needed. The 12/17 encounter is is being flagged for the measure; however, the patient did not have a STEMI during this encounter and while the patient did go to the cath lab, there was no intervention because no intervention was needed. STEMI is listed on the coding summary (as a secondary diagnosis) appropriately since the event occurred within four weeks of the original encounter. Because the logic looks for STEMI in any diagnosis, this patient is inappropriately flagged for the measure.  It is my recommendation that the logic be changed to look for STEMI only as the principal or primary diagnosis. STEMI patients have a high risk of readmission within 30 days so this issue can be common and also does not measure quality care as the intent of the measure.

      [Suggested resolution retained from the Solution field]: Change the logic to flag only principal diagnosis of STEMI and not all diagnoses of STEMI.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Connie Owen
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