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Core Measures An Overview

Core Measures An Overview. October, 2009. What are the Core Measures?. A Standard set of data elements that are… Based on: Evidence-based medicine Large scale scientific studies with proven efficacy Related to: Specific diagnoses / medical conditions

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Core Measures An Overview

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  1. Core MeasuresAn Overview October, 2009

  2. What are the Core Measures? A Standard set of data elements that are… Based on: • Evidence-based medicine • Large scale scientific studies with proven efficacy Related to: • Specific diagnoses / medical conditions • Specific patient care actions and outcomes

  3. Scientific studies have been incorporated into guidelines developed by professional organizations • Consensus of national experts panel for each measure • Proven to be measurable and reliable measures of the quality of care • Focus on clinical processes: all patients, without contraindications, should be considered candidates for therapies

  4. Why did CMS develop the Core Measures? • Topics focus on health problems most common to the Medicare population • Effective interventions have been shown to reduce disability and save lives • Based on national data, many Medicare patients do not receive important therapies known to decrease morbidity and mortality

  5. To whom are these measures reported? • Reported to: • Government and regulatory agencies • CMS – Center for Medicare & Medicaid Services • TJC – The Joint Commission • The public via websites • hospitalcompare.hhs.gov (CMS site) • qualitycheck.org (TJC site)

  6. Inpatient Core Measure Groups • Acute Myocardial Infarction (AMI) • Congestive Heart Failure (HF) • Pneumonia (PN) • Surgical Care Improvement Project (SCIP) • Childhood Asthma Prevention (CAC)

  7. AMI Measures AMI 1 Aspirin w/in 24 hours of arrival* The early use of aspirin in patients with acute myocardial infarction results in a significant reduction in adverse events and subsequent mortality AMI-2 Aspirin at discharge.* Studies have demonstrated that aspirin canreduce this risk by 20%

  8. AMI Measures AMI-3 ACEI or ARB for LVSD* ACEI therapy reduces mortality and morbidity in patients with left ventricular systolic dysfunction (LVSD) after AMI

  9. AMI Measures AMI- 4 Smoking Cessation Counseling Smoking cessation reduces mortality and morbidity in all populations. Patients who receive even brief smoking-cessation advice from their care providers are more likely to quit. Same for HF-4 and PN-4

  10. AMI Measures AMI-5 Beta Blocker at discharge* Beta blockers prescribed for patients who have suffered an acute myocardial infarction can reduce mortality and morbidity. Studies have demonstrated that the use of beta blockers is associated with about a 20% risk reduction

  11. AMI Measures AMI-7 Median time to fibrinolysis AMI-7a Thrombolytic Agent received within 30 minutes of arrival • Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. • Consider that nearly 2 lives per 1000 patients are lost per hour of delay

  12. AMI Measures AMI-8 Median time to PCI AMI-8a PCI received within 90 minutes of patient arrival • The early use of primary angioplasty in patients with acute myocardial infarction who present with ST-segment elevation or LBBB results in a significant reduction in mortality and morbidity • The earlier primary coronary intervention is provided, the greater its effect

  13. Heart Failure Measures HF –1 Discharge Instructions Written instructions or educational material must address all of the following: • Activity level • Diet • A written list of discharge medications • Follow-up appointment • Weight monitoring • What to do if symptoms worsen

  14. Heart Failure Measures HF-2 LVF assessment* The identification of patients with impaired left ventricular systolic function is required in order to treat with appropriate selection of medications to reduce morbidity and mortality in heart failure

  15. Heart Failure Measures HF-3 ACEI or ARB for LVSD* ACEI/ARB therapy reduces mortality and morbidity in patients with heart failure and left ventricular systolic dysfunction

  16. Pneumonia Measures PN-2 Pneumococcal vaccination* Pneumococcal vaccination is indicated for persons 65 years of age and older, because it is up to 75% effective in preventing pneumococcalbacteremia and meningitis. PN-3a Blood cultures performed w/in 24 hours prior to or after admission to the ICU PN-3b- Blood cultures preformed in the ED before the initial antibiotic Published treatment guidelines recommend the collection of blood cultures for all inpatients with severe pneumonia to optimize therapy

  17. Pneumonia Measures PN-5c - Initial antibiotic received within6 hours of Arrival … clinical evidence of an association between timely inpatient administration of antibiotics and improved outcome among pneumonia patients

  18. Pneumonia Measures PN-6 Initial antibiotic selection for CAP -6a ICU patient -6b Non- ICU patient • PN-7 • Pneumonia patients age ≥ 50 yo, hospitalized during October, November, December, January, February or March who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated.

  19. Surgical Care ImprovementProject Prophylactic Antibiotics • SCIP-Inf 1Prophylactic Antibiotics given within one hour of anesthesia start time • SCIP-Inf 2 Appropriate antibiotic selection • SCIP-Inf 3 Stopped within 24 hours after anesthesia end time (48 hours for cardiac surgery)

  20. Surgical Care Improvement Project • SCIP-Inf 4 Controlled 0600 Blood Glucose (Cardiac Surgery Patients only)Several studies have demonstrated a strong relationship between hyperglycemia and surgical site infections. • SCIP-Inf 6 Appropriate Hair Removal Shaving predisposes to infection by creating tiny cuts and abrasions in the dermal surface). • SCIP-Card 2 Perioperative Beta Blocker Administration Patients on chronic beta blocker therapy experience an increase in morbidity and mortality if beta blockers are omitted in the perioperative period. ADMRO needs the date and time of last dose taken and communicate this in Hand-off to POHA-CRNA-PACU.

  21. Surgical Care Improvement Project • SCIP-Inf 9 Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zero. It is well–established that the risk of catheter-associated urinary tract infection (UTI) increases with increasing duration of indwelling urinary catheterization. • SCIP-Inf 10 Surgery Patients with Perioperative Temperature Management For the purpose of maintaining normothermia one body temperature equal to or greater than 96.8° F/36° C recorded within the 30 minutes immediately prior to or the 15 minutes immediately after Anesthesia End Time abstracted. (For PACU/OR only) Core temperatures outside the normal range pose a risk in all patients undergoing surgery.

  22. Surgical Care Improvement Project SCIP-VTE-1 Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered SCIP-VTE-2 Surgery Patients Who Received Appropriate VTE Prophylaxis Within 24 Hours Prior to Surgery to 24 Hours After Surgery

  23. Goals: • Better outcomes for our patients. • Shorter lengths of stay. • Fewer complications. • Improved compliance and reimbursement. • Being wiser, smarter caregivers.

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