Release Notes:
Measure Information Form
Version 2010B
**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**Measure Information Form
Measure Set: Acute Myocardial Infarction(AMI)
Set Measure ID: AMI-7a
Performance Measure Name: Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival
Description: Acute myocardial infarction (AMI) patients receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less
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: Increase in the rate
Numerator Statement: AMI patients whose time from hospital arrival to fibrinolysis is 30 minutes or less
Included Populations: Not applicable
Excluded Populations: None
Data Elements:
Denominator Statement: AMI patients with ST-elevation or LBBB on ECG who received fibrinolytic therapy
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:
Continuous Variable Statement:
Included Populations:
Excluded Populations:
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 measure rate for fibrinolytic agent received within 30 minutes of hospital arrival should be analyzed in conjunction with the median time to fibrinolysis measure (AMI-7). These measures, used together, will assist in understanding the number of AMI patients that are receiving fibrinolysis within 30 minutes of hospital arrival and will identify the hospital’s median time to fibrinolysis and potential opportunities for improvement to increase the rate of patients receiving fibrinolysis in 30 minutes or less.
Sampling: Yes. For additional information see the Sampling Section.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
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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