DOC

LDL cholesterol assessment

By Danielle Young,2015-01-13 16:29
6 views 0
Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-1 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09) Measure Information Form Clinical Area: Acute Myocardial Infarction (AMI) Measure ID#: HQID-10 Performance Measure Name: LDL-Cholesterol Assessment Description: Acute myocardial infarction (AMI) patien..

    Measure Information Form

Clinical Area: Acute Myocardial Infarction (AMI)

Measure ID#: HQID-10

Performance Measure Name: LDL-Cholesterol Assessment

    Description: Acute myocardial infarction (AMI) patients with documentation of low-density lipoprotein cholesterol (LDL-c) level in the hospital record or documentation that LDL-c testing was done during the hospital stay or is planned for after discharge.

    Rationale: The reduction of LDL-c reduces mortality and morbidity in patients with coronary artery disease (CAD). Placebo-controlled trials demonstrate a 30 to 40% relative risk reduction in cardiovascular endpoints with lipid-lowering therapy in a broad range of patients with established CAD (Collins, 2003 and Shepherd, 2002). The National Cholesterol Education Panel and the ACC/AHA recommend lipid screening and lipid lowering, particularly LDL-c reduction, in patients with CAD and hyperlipidemia (NCEP ATP III, 2001; Antman, 2004; and Smith, 2001). The ACC/AHA ST-Elevation Myocardial Infarction guidelines also recommend that lipid measurements should be performed or obtained from prior medical records for all patients (Antman, 2004). Despite the increasing evidence to support lipid testing to direct therapy, many eligible older patients hospitalized with AMI do not have measurements of their lipid levels performed (Foody, 2005).

Type of Measure: Process; CMS Test

Improvement Noted As: An increase in the rate

    Numerator Statement: AMI patients with documentation of LDL-c level in the hospital record or documentation that LDL-c testing was done either during the hospital stay or is planned for after discharge

    Included Populations: Not Applicable

    Excluded Populations: None

    Data Elements:

    ; In-Hospital LDL-Cholesterol Test

    ; Plan for LDL-Cholesterol Test

    ; Pre-Arrival LDL-Cholesterol Qualitative Description

    ; Pre-Arrival LDL-Cholesterol Test

    ; Pre-Arrival LDL-Cholesterol Value

    Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-1 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)

Denominator Statement: AMI patients

    Included Populations:

    Discharges with an ICD-9-CM Principal Diagnosis Code for AMI as defined in HQID

    Appendix A, Table 1.1

    Excluded Populations:

    ; Patients less than 18 years of age

    ; Patients who have a Length of Stay >120 days

    ; Patients with Comfort Measures Only documented

    ; Patients enrolled in clinical trials

    ; Patients discharged/transferred to another hospital for inpatient care

    ; Patients who left against medical advice or discontinued care

    ; Patients who expired

    ; Patients discharged/transferred to a federal health care facility

    ; Patients discharged/transferred to hospice

    ; Lipid-lowering medication as pre-arrival medication

    ; Patients with reason documented by a physician/advanced practice nurse/physician

    assistant for no LDL-c testing

    Data Elements:

    ; Admission Date

    ; Birthdate

    ; Clinical Trial

    ; Comfort Measures Only

    ; Discharge Date

    ; Discharge Status

    ; ICD-9-CM Principal Diagnosis Code

    ; Pre-Arrival Lipid-Lowering Agent

    ; Reason for No LDL-Cholesterol Testing

Risk Adjustment: No

    Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

    Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

    Sampling: Yes, for additional information see the Population and Sampling Specifications section NHQM version 2.6b.

    Data Reported As: Aggregate rate generated from count data reported as a proportion

Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-2 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)

Selected References:

    ; Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II,

    Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK,

    Wright RS. ACC/AHA 2007 guidelines for the management of patients with unstable

    angina/nonST-elevation myocardial infarction: a report of the American College of

    Cardiology/American Heart Association Task Force on Practice Guidelines (Writing

    Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable

    Angina/NonST-Elevation Myocardial Infarction): developed in collaboration with the

    American College of Emergency Physicians, American College of Physicians, Society for

    Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions,

    and Society of Thoracic Surgeons. J Am Coll Cardiol 2007;50:e1157.

    ; Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS,

    Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA,

    Smith SC Jr. ACC/AHA guidelines for the management of patients with ST-elevation

    myocardial infarction: a report of the American College of Cardiology/American Heart

    Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for

    the Management of Patients With Acute Myocardial Infarction). 2004. ; Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of

    cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-

    controlled trial. Lancet. 2003;361:2005-2016.

    ; Executive Summary of the Third Report of the National Cholesterol Education Program

    (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in

    Adults (Adult Treatment Panel III). JAMA 2001;285:2486-2497.

    ; Foody JM, Roe MT, Chen AY, Smith SC Jr, Brindis RG, Peterson ED, Gibler WB, Ohman

    EM; CRUSADE Investigators. Lipid management in patients with unstable angina pectoris

    and non-ST-segment elevation acute myocardial infarction (from CRUSADE). Am J Cardiol.

    2005 Feb 15;95(4):483-5.

    ; Grundy SM, Cleeman JI, Merz CNB et al. Implications of Recent Clinical Trials for the

    National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation.

    2004;110:227-239.

    ; Krumholz HM, Anderson JL, Brooks NH, Fesmir FM, Lambrew CT, Landrum MB, Weaver

    WD, Whyte J. ACC/AHA Clinical Performance Measures for Adults With ST-Elevation and

    NonST-Elevation Myocardial Infarction: a report of the ACC/AHA Task Force on

    Performance Measures (ST-Elevation and NonST-Elevation Myocardial Infarction

    Performance Measures Writing Committee). J Am Coll Cardiol 2006;47:23665. Available

    at http://www.acc.org and http://www.americanheart.org.

    ; Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A,

    Grundy SM, Houston Miller N, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I,

    Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. AHA/ACC guidelines for

    preventing heart attack and death in patients with atherosclerotic cardiovascular disease:

    2001 update. Circulation 2001;104:1577-1579.

    ; Shepherd J, Blauw GJ, Murphy MB et al. Pravastatin in elderly individuals at risk of vascular

    disease (PROSPER): a randomized controlled trial. Lancet. 2002;360:1623-1630. Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-3 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)

HQID-10: LDL-Cholesterol Assessment (CMS Test)

    Numerator:AMI patients with documentation of LDL-c level in the hospital record or

    documentation that LDL-c testing was done either during the hospital stay or is

    planned for after discharge.

    Denominator:AMI patients.

    START

    Run cases that are included in the AMI Initial Patient Population and pass the edits defined in the Data Processing Flow through this measure.

    HQID-10HQID-10Comfort Missing = 1, 2, 3XBMeasures Only

    = 4

    HQID-10HQID-10MissingClinical Trial = YXB

    = N

    HQID-10H

    Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-4 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)

    HQID-10H

    HQID-10= 02, 07, 20,BDischarge Status 43, 50, 51, 66

    = 01, 03, 04, 05, 06, 61, 62, 63, 64, 65, 70

    HQID-10HQID-10Pre-Arrival XMissing = YBLipid-Lowering Agent

     = N

    HQID-10In-Hospital LDL- = YMissingXCholesterol Test

    = N

    HQID-10HQID-10Pre-Arrival LDL-I = NMissingXCholesterol Test

    = Y

    Pre-Arrival LDL-HQID-10XMissingNon-UTDCholesterol Value

    = UTD

    HQID-10Pre-Arrival LDL-HQID-10XMissingCholesterol Qualitative = 1 or 2EDescription

    = 3

    HQID-10I

    Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-5 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)

    HQID-10HQID-10IE

    Plan for HQID-10In Numerator MissingLDL-Cholesterol = YZPopulationTestEHQID-10XHQID-10= NB

    Reason for NoCase WillNot In Measure MissingLDL-Cholesterol = YBe RejectedPopulationTestingXB

    = N

    In Measure PopulationD

    HQID-10Z

    Stop

    Source: Specifications Manual for National Hospital Inpatient Quality Measures HQID-10-6 Discharges 04-01-09 (2Q09) through 09-30-09 (3Q09)

Report this document

For any questions or suggestions please email
cust-service@docsford.com