Performance Measurement Network

Question: Reason for Extending the Initiation of IV Thrombolytic

Please provide clarification for this new element -

If tPA is given within 3-4.5 hours of time last know well and there is a documented reason for the delay, will this patient be excluded from the STK-4 denominator?

Was there a disadvantage before this new element?

What is the benefit of the new element?

Answer:

If tPA is given within 3-4.5 hours of "Time Last Known Well" and there is a documented reason for the delay (i.e., patient or medical reasons; system delays do not count, then the patient will be excluded from the STK-4 denominator by selecting 'YES' for the data element "Reason for Extending the Initiation of IV Thrombolytic".

Was there a disadvantage before this new element? There was no disadvantage prior to the addition of this data element. Previously, such cases were excluded using Notes for Abstraction in the data element "IV Thrombolytic Initiation". • When IV thrombolytic therapy is initiated beyond 3 hours (180 min. because a reason for not initiating IV thrombolytic therapy existed during the 3 hour timeframe, select “No.” Examples: o Patient arrives in the emergency department within 2 hours of time last known well. Blood pressure 195/110 mmHg on arrival. Physician documents that patient is within the t-PA window, but blood pressure is an issue. Elevated blood pressure treated prior to t-PA administration. IV thrombolytic therapy administered at 3 hours and 30 minutes from time last known well. o Patient arrives in the emergency department within 2 hours of time last known well and refuses t-PA. Family arrives and after further discussion with them, patient consents to t-PA. IV thrombolytic therapy administered 4 hours later.

What is the benefit of the new element? With the addition of the new data element "Reason for Extending the Initiation of IV Thrombolytic", the notes for abstraction in the "IV Thrombolytic Therapy" data element have been removed. Since the patient did in fact receive IV tPA, this workaround was counterintuitive and therefore replaced with the new data element which clearly excludes these cases. With more hospitals collecting stroke measure data for CMS HIQR as well as TJC, the addition of this new data element and subsequent adjustment of the algorithm improves measure flow logic and data capture for the CMS and TJC data warehouses. )

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: STK, STK-04,
File:

Copyright © by the contributing authors. All material on this collaboration platform is the property of the contributing authors.
Ideas, requests, problems regarding Performance Measurement Network? Send feedback