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  • Measure Summary
  • NQMC:004290
  • NQF-Endorsed Measure

Acute myocardial infarction: median time to transfer to another facility for acute coronary intervention.

Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 2.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2009. 245 p.

This is the current release of the measure.

Primary Measure Domain

Process

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Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the median time (in minutes) from emergency department (ED) arrival to time of transfer to another facility for acute coronary intervention in acute myocardial infarction (AMI) patients 18 years and older.

Rationale

The early use of primary angioplasty in patients with acute myocardial infarction (AMI) who present with ST-segment elevation or left bundle branch block (LBBB) results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is. National guidelines recommend the prompt initiation of percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction. Despite these recommendations, few eligible older patients hospitalized with AMI receive primary angioplasty within a timely manner. Patients transferred for primary PCI rarely meet recommended guidelines for door-to-balloon time. Times to treatment in transfer patients undergoing primary PCI may influence the use of PCI as an intervention. Current recommendations support a door-to-balloon time of 90 minutes or less.

Primary Clinical Component

Acute myocardial infarction (AMI); ST-segment elevation; left bundle branch block (LBBB); acute coronary intervention; transfer

Denominator Description

Patients 18 years and older with an emergency department (ED) encounter who were discharged/transferred to a short-term general hospital for inpatient care or to a Federal healthcare facility with a diagnosis of acute myocardial infarction (AMI) and ST-segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG) performed closest to ED arrival and who were transferred for acute coronary intervention

Numerator Description

Continuous variable statement: Time (in minutes) from emergency department (ED) arrival to transfer to another facility for acute coronary intervention

Evidence Supporting the Criterion of Quality

A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Need for the Measure

Overall poor quality for the performance measured

Use of this measure to improve performance

Evidence Supporting Need for the Measure

Jencks SF, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE, Nilasena DS, Ordin DL, Arday DR. Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. JAMA. 2000 Oct 4;284(13):1670-6. PubMed External Web Site Policy

Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005 Feb 15;111(6):761-7. [32 references] PubMed External Web Site Policy

State of Use

Current routine use

Current Use

External oversight/Medicare

Internal quality improvement

Care Setting

Hospitals

Professionals Responsible for Health Care

Measure is not provider specific

Lowest Level of Health Care Delivery Addressed

Single Health Care Delivery Organizations

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

Stratification by Vulnerable Populations

Unspecified

Source(s)

Centers for Medicare & Medicaid Services (CMS). Specifications manual for hospital outpatient department quality measures (v 2.1a). Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2009. 245 p.

Incidence/Prevalence

Unspecified

Association with Vulnerable Populations

See the "Rationale" field.

Burden of Illness

Unspecified

Utilization

Unspecified

Costs

Unspecified

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Timeliness

Case Finding

Users of care only

Description of Case Finding

Patients 18 years and older with an emergency department (ED) encounter who were discharged/transferred to a short-term general hospital for inpatient care or to a Federal healthcare facility with a diagnosis of acute myocardial infarction (AMI) and ST-segment elevation or left bundle branch block (LBBB) on electrocardiogram (ECG) performed closest to ED arrival and who were transferred for acute coronary intervention (see the "Denominator Inclusions/Exclusions" field)

Denominator Sampling Frame

Patients associated with provider

Denominator Inclusions/Exclusions

Inclusions

  • An E/M Code for emergency department (ED) encounter as defined in Appendix A, OP Table 1.0*
  • Patients discharged/transferred to a short-term general hospital for inpatient care or to a Federal healthcare facility
  • An International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Diagnosis Code for acute myocardial infarction (AMI) as defined in Appendix A, OP Table 1.1*
  • ST-segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to ED arrival
  • Patients with Transfer for Acute Coronary Intervention as defined in the Data Dictionary*

Exclusions

  • Patients less than 18 years of age
  • Patients receiving Fibrinolytic Administration as defined in the Data Dictionary*

*Refer to the original measure documentation for details.

Relationship of Denominator to Numerator

All cases in the denominator are equally eligible to appear in the numerator

Denominator (Index) Event

Clinical Condition

Diagnostic Evaluation

Encounter

Institutionalization

Therapeutic Intervention

Denominator Time Window

Time window follows index event

Numerator Inclusions/Exclusions

Inclusions
Continuous variable statement: Time (in minutes) from emergency department (ED) arrival to transfer to another facility for acute coronary intervention

Exclusions
None

Measure Results Under Control of Health Care Professionals, Organizations and/or Policymakers

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Numerator Time Window

Fixed time period

Data Source

Administrative data

Medical record

Level of Determination of Quality

Not Individual Case

Pre-existing Instrument Used

Unspecified

Scoring

Continuous Variable

Interpretation of Score

Better quality is associated with a lower score

Allowance for Patient Factors

Unspecified

Standard of Comparison

External comparison at a point in time

External comparison of time trends

Internal time comparison

Original Title

OP-3: hospital outpatient acute myocardial infarction: median time to transfer to another facility for acute coronary intervention.

Measure Collection Name

Hospital Outpatient Department Quality Measures

Measure Set Name

Hospital Outpatient Acute Myocardial Infarction

Submitter

Centers for Medicare & Medicaid Services

Developer

Centers for Medicare & Medicaid Services

Funding Source(s)

United States Department of Health and Human Services

Composition of the Group that Developed the Measure

Centers for Medicare & Medicaid (CMS) Contractor

Financial Disclosures/Other Potential Conflicts of Interest

None

Endorser

National Quality Forum

Included in

Hospital Quality Alliance

Adaptation

Measure was not adapted from another source.

Release Date

2008 Apr

Revision Date

2009 Jan

Measure Status

This is the current release of the measure.

Measure Availability

The individual measure, "OP-3: Hospital Outpatient Acute Myocardial Infarction: Median Time to Transfer to Another Facility for Acute Coronary Intervention," is published in the "Specifications Manual for Hospital Outpatient Department Quality Measures (Version 2.1a)." This document is available from the QualityNet Web site External Web Site Policy. Check the QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

NQMC Status

This NQMC summary was completed by ECRI Institute on February 20, 2009. The information was verified by the measure developer on May 8, 2009.

Copyright Statement

No copyright restrictions apply.

The Specifications Manual for Hospital Outpatient Department Quality Measures (Version 2.1a, January 2009) is periodically updated by the Centers for Medicare & Medicaid Services. Users of the Specifications Manual for Hospital Outpatient Department Quality Measures must update their software and associated documentation based on the published manual production timelines.

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