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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-6

Set Measure ID Performance Measure Name
PN-6b * Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients – Non ICU Patients
PN-6a * Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients – Intensive Care Unit (ICU) Patients
* Joint Commission Only

Performance Measure Name: Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients

Description: Immunocompetent patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines.

Note: CMS data is transmitted as patient level data while the Joint Commission’s data is transmitted as aggregate level data. Therefore, in order for The Joint Commission to distinguish between ICU and non-ICU patients, two separate measures (PN-6a and PN-6b) are required for data transmission.

Rationale: The current North American antibiotic guidelines for Community-Acquired Pneumonia in immunocompetent patients are from the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America (IDSA), the Canadian Infectious Disease Society / Canadian Thoracic Society (CIDS/CTS), and the American Thoracic Society (ATS). All four reflect that Streptococcus pneumoniae is the most common cause of CAP, that treatment that covers “atypical” pathogens (e.g., Legionella species, Chlamydia pneumoniae, Mycoplasma pneumoniae) can be associated with improved survival, and that the prevalence of antibiotic resistant S. pneumoniae is increasing.

The CMS convened a conference of guideline authors, including Julie Gerberding, MD (CDC), John Bartlett, MD (IDSA), Ronald Grossman, MD (CIDS/CTS), and Michael Niederman, MD (ATS), to reach consensus on the antibiotic regimens that could be considered consistent with all four organizations’ guidelines. These regimens are reflected in this measure, and in the Pneumonia Antibiotic Consensus Recommendation located directly behind the measure information form.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Pneumonia patients who received an initial antibiotic regimen (as specified under the Set Measure Identifier and description above) consistent with current guidelines during the first 24 hours of their hospitalization
Included Populations: Pneumonia patients who received antibiotics consistent with current guidelines

Excluded Populations: None

Data Elements:

Note: The data element Risk Factors for Drug-Resistant Pneumococcus applies to PN-6 and PN-6b only

Denominator Statement: Pneumonia patients (as specified under the Set Measure Identifier and description above) 18 years of age and older

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 on day of or day after arrival
  • Patients enrolled in clinical trials
  • Patients received as a transfer from the emergency department of another hospital
  • Patients received as a transfer from an acute care facility where they were an inpatient or outpatient
  • Patients received as a transfer from one distinct unit of the hospital to another distinct unit of the same hospital
  • Patients received as a transfer from an ambulatory surgery center
  • Patients who have no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression
  • PN patients not in the ICU (PN-6a only)
  • PN patients in ICU (PN-6b only)
  • Patients with an Identified Pathogen as defined in the Data Dictionary
  • Patients with Healthcare Associated PN as defined in the Data Dictionary
  • Patients who are Compromised as defined in the Data Dictionary
  • Patients who only received antibiotics prior to hospital arrival
  • Patients who do not receive any antibiotics within 24 hours after arrival.
  • Patients discharged/transferred to another hospital for inpatient care on day of or day after arrival
  • Patients who left against medical advice or discontinued care on day of or day after arrival
  • Patients who expired on day of or day after arrival
  • Patients discharged/transferred to a federal health care facility on day of or day after arrival
  • Pneumonia patients with another suspected source of infection who did not receive an antibiotic regimen recommended for pneumonia, but did receive antibiotics within the first 24 hours of hospitalization

Data Elements:

Note: The data element Risk Factors for Drug-Resistant Pneumococcus applies to PN-6 and PN-6b only

Risk Adjustment: No.

Data Collection Approach: Retrospective, data sources for required data elements include administrative data and medical record documents. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunity for improvement at the point of care/service. However, complete documentation includes the final 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: The time of antibiotic administration is critical to this measure. For quality improvement purposes, the measurement system may want to create reports to identify patients who received their antibiotic consistent with guidelines but greater than 24 hours from the time of arrival, and patients who did not receive an antibiotic consistent with guidelines. This will allow healthcare organizations to direct education effort in the appropriate direction (i.e., appropriate antibiotic selection, or timing of administration).

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

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

Selected References:

  • Butler JC, Hofmann J, Cetron MS, et al. The continued emergence of drug-resistant Streptococcus pneumonia in the United States: an update from the Centers for Disease Control and Prevention’s Pneumococcal Sentinel Surveillance System. J Infect Dis. 1996;174:986-993.
  • Fine MJ, Smith MA, Carson CA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. JAMA. 1996;275:134-141.
  • Gleason PP, Meehan TP, Fine JM, et al. Associations between initial antimicrobial regimens and medical outcomes for elderly patients with pneumonia. Arch Intern Med. 1999;159:2562-2572.
  • Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, et al. Management of Community-Acquired Pneumonia in the era of pneumococcal resistance: A Report From the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. Archives of Internal Medicine. 2000, 160:1399-1408.
  • Houck PM, MacLehose RF, Niederman MS, Lowery JK. Empiric antibiotic therapy and mortality among Medicare pneumonia inpatients in 10 western states, 1993, 1995, and 1997. Chest. 2001;119;1420-1426.
  • Mandell LA, Marrie TJ, Grossman RF, et al. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Disease Society and the Canadian Thoracic Society. Clin Infect Dis. 2000;31:383-421.
  • 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.

Measure Algorithm:

Attach file

Related Topics

Measure Information Form PN-6
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)