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Release Notes:
Measure Information Form
Version 2010A1


**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Measure Set: Pneumonia(PN)

Set Measure ID: PN-4

Performance Measure Name: Adult Smoking Cessation Advice/Counseling

Description: Pneumonia patients with a history of smoking cigarettes who are given smoking cessation advice or counseling during hospital stay. For the purposes of this measure, a smoker is defined as someone who has smoked cigarettes anytime during the year prior to hospital arrival.

Rationale: Tobacco use is the single greatest cause of disease in the United States today. Smoking accounts for one out of every five deaths in the United States and is the most important modifiable cause of premature death. Smoking cessation treatments ranging from brief clinician advice to specialist-delivered intensive programs, including pharmacotherapy, are not only clinically effective, but also are extremely cost-effective relative to other commonly used disease prevention interventions and medical treatments. Hospitalization can be an ideal opportunity for a patient to stop smoking, and smoking cessation may promote the patient’s medical recovery. Patients who receive even brief smoking-cessation advice from their care providers are more likely to quit than those who receive no counseling whatsoever.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Pneumonia patients (cigarette smokers) who receive smoking cessation advice or counseling during the hospital stay
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Pneumonia patients 18 years of age and older with a history of smoking cigarettes anytime during the year prior to hospital arrival

Included Populations: Discharges with:
  • An ICD-9-CM Principal Diagnosis Code of pneumonia as defined in Appendix A, Table 3.1 OR ICD-9-CM Principal Diagnosis Code of septicemia or respiratory failure (acute or chronic) as defined in Appendix A, Tables 3.2, or 3.3
    AND
  • An ICD-9-CM Other Diagnosis Code of pneumonia (Appendix A, Table 3.1)

Excluded Populations:

  • Patients less than 18 years of age
  • Patients who have a Length of Stay >120 days
  • Patients with Cystic Fibrosis (Appendix A, Table 3.4)
  • Patients who had no chest x-ray or CT scan that indicated abnormal findings within 24 hours prior to hospital arrival or anytime during this hospitalization
  • 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

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective, data sources for required data elements and medical record documents. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal and other ICD-9-CM diagnosis and procedure codes, which require retrospective data entry.

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: For the data element Adult Smoking History, measurement systems may want to provide drill down information for analysis on the data element value of “not documented or not assessed”. This will enable the measurement system to provide health care organizations data on the number of patients where history of smoking is not on the patient record.

Sampling: Yes. For additional information see the Sampling Section.

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

Selected References:

  • Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department or Health and Human Services. Public Health Service. June 2000.
  • Hudmon KS, Hemberger KK, Corelli RL, et al. The pharmacist’s role in smoking cessation counseling: perceptions of users of nonprescription nicotine replacement therapy. J Am Pharm Assoc 2003; 43(5):573-582.
  • Kikano GE, et al: The value of brief, targeted smoking-cessation advice. Family Practice Management. pp. 50-2000.
  • Mandell LA, Wunderink RG, Anzueta A, Bartlett JG, Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 March 1;44 Suppl 2:S27-72.
  • Sheahan SL. How to help older adults quit smoking. Nurse Pract 2002; 27:27-33.
  • The Smoking Cessation Clinical Practice Guideline Panel and Staff: The Agency for Health Care Policy and Research. Smoking Cessation Clinical Practice Guideline. JAMA, 275:1270-1280, 1996.

Measure Algorithm:

Attach file

Related Topics

Measure Information Form PN-4
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)