Release Notes:
Measure Information Form
Version 2010A1
Measure Information Form
Measure Set: Acute Myocardial Infarction(AMI)
Set Measure ID: AMI-7
Performance Measure Name: Median Time to Fibrinolysis
Description: Median time from arrival to administration of fibrinolytic agent in patients with ST-segment elevation or left bundle branch block (LBBB) on the electrocardiogram (ECG) performed closest to hospital arrival time
Rationale: Time to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. Nearly 2 lives per 1000 patients are lost per hour of delay (Fibrinolytic Therapy Trialists' Collaborative Group, 1994). National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-elevation myocardial infarction (Antman, 2004). Despite these recommendations, few eligible older patients hospitalized with AMI receive timely fibrinolytic therapy (Jencks, 2000).
Type of Measure: Process
Improvement Noted As: Decrease in the median value
Numerator Statement:
Included Populations:
Excluded Populations:
Data Elements:
Denominator Statement:
Included Populations:
Excluded Populations:
Data Elements:
Continuous Variable Statement: Time (in minutes) from hospital arrival to administration of fibrinolytic therapy in patients with ST-segment elevation or LBBB on the ECG performed closest to hospital arrival
Included Populations:
Discharges with:
- An ICD-9-CM Principal Diagnosis Code for AMI as defined in Appendix A, Table 1.1
AND
- ST-segment elevation or LBBB on the ECG performed closest to hospital arrival
AND
- Fibrinolytic therapy within 6 hours after hospital arrival
AND
- Fibrinolytic therapy is primary reperfusion therapy
Excluded Populations:
- Patients less than 18 years of age
- Patients who have a Length of Stay >120 days
- Patients with Comfort Measures Only documented on day of or day after arrival
- Patients enrolled in clinical trials
- 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 the emergency department of another hospital
- Patients who did not receive fibrinolytic therapy within 30 minutes and had a reason for delay documented by a physician/advanced practice nurse/physician assistant (e.g., social, religious, initial concern or refusal, cardiopulmonary arrest)
Data Elements:
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: The median time to fibrinolysis should be analyzed in conjunction with the measure rate for fibrinolysis received within 30 minutes of hospital arrival (AMI-7a). These measures, used together, will assist in understanding the median time to fibrinolysis and will identify the number of AMI patients that are receiving fibrinolysis within 30 minutes of hospital arrival and potential opportunities for improvement to decrease the median time to fibrinolysis.
Sampling: Yes. For additional information see the Sampling Section.
Data Reported As: Aggregate measure of central tendency .
Selected References:
- 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.
- Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet. 1994; 343:311-22.
- Jencks SJ, 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; 284:1670-1676.
- 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 Non–ST-Elevation Myocardial Infarction: a report of the ACC/AHA Task Force on Performance Measures (ST-Elevation and Non-ST-Elevation Myocardial Infarction Performance Measures Writing Committee). J Am Coll Cardiol 2006; 47:236–65. Available at http://www.acc.org and http://www.americanheart.org.
Measure Algorithm:
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