Introduction
to
Core Measures
Lynn Benson
Preferred Nurse Staffing
Core Measures
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Who is information reported to?
– JCAHO
– CMS
– National Patient Safety Foundation
ACM Measures
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Ten Appropriate Care Measures (ACM)
are designated by an asterisk*.
Asks: has a patient received all the care he
or she was eligible to receive based on tenmeasures (5 AMI, 2 HF, and 3 PN)?
Measures how often the hospital “gets it
right.”
Focuses on providing “the right care for
every person every time.”
Core Measures
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Public has access to quality
information through the Internet
– How does Riley Hospital measure up??
– Check it out at
http://www.hospitalcompare.hhs.gov
Core Measures
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Topics focus on health problems most
common to the Medicare population
Effective interventions have been shown to
reduce disability and save lives
Based on national data, many Medicare
patients do not receive important therapies
known to decrease morbidity and mortality
Inpatient Core Measure
Groups
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Acute Myocardial Infarction (AMI)
Congestive Heart Failure (HF)
Pneumonia (PN)
Surgical Care Improvement Project
(SCIP)
Childhood Asthma Prevention
Core Measures
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Based on large scale scientific studies with proven
efficacy
Scientific studies have been incorporated into
guidelines developed by professional organizations
Consensus of national experts panel for each
measure
Proven to be measurable and reliable measures of
the quality of care
Focus on clinical processes: all patients, without
contraindications, should be considered candidates
for therapies
AMI Measures
AMI 1 Aspirin w/in 24 hours of arrival*
The early use of aspirin in patients with acute
myocardial infarction results in a significant
reduction in adverse events and subsequent
mortality
AMI-2 Aspirin at discharge.*
Studies have demonstrated that aspirin can
reduce this risk by 20%
AMI Measures
AMI-3
ACEI or ARB for LVSD*
ACEI therapy reduces mortality and morbidity in
patients with left ventricular systolic dysfunction
(LVSD/EF less than 40%) after AMI
AMI Measures
AMI- 4
Smoking Cessation
Counseling
Smoking cessation reduces mortality and
morbidity in all populations. Patients who
receive even brief smoking-cessation advice
from their care providers are more likely to
quit
AMI Measures
AMI-5
Beta Blocker at discharge*
Beta blockers prescribed for patients who
have suffered an acute myocardial infarction
can reduce mortality and morbidity.
Studies have demonstrated that the use of
beta blockers is associated with about a
20% risk reduction
AMI Measures
AMI-6
RETIRED
Beta Blocker at arrival*
AMI Measures
AMI-7 Median time to fibrinolysis
AMI-7a Thrombolytic Agent received
within 30 minutes of arrival
Time to fibrinolytic therapy is a strong predictor of
outcome in patients with an acute myocardial
infarction.
Consider that nearly 2 lives per 1000 patients are
lost per hour of delay
AMI Measures
AMI-8 Median time to PCI
AMI-8a PCI received within 90 minutes of
patient arrival
The early use of primary angioplasty in patients
with acute myocardial infarction who present with
ST-segment elevation or LBBB results in a
significant reduction in mortality and morbidity
The earlier primary coronary intervention is
provided, the greater its effect
Heart Failure Measures
HF –1 Discharge Instructions
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Written instructions or educational material must
address all of the following and must be specific to
heart failure:
Activity level
Diet
A written list of discharge medications
Follow-up appointment
Weight monitoring
What to do if heart failure symptoms worsen
Heart Failure Measures
HF-2
LVF assessment*
Appropriate selection of medications to reduce
morbidity and mortality in heart failure requires
the identification of patients with impaired left
ventricular systolic function (Ejection fraction
less than 40%)
Heart Failure Measures
HF-3
ACEI or ARB for LVSD*
ACEI therapy reduces mortality and morbidity in
patients with heart failure and left ventricular
systolic dysfunction
Heart Failure Measures
HF-4
Smoking Cessation/counseling
Smoking cessation reduces mortality and
morbidity in all populations
Patients who receive even brief smokingcessation advice from their care providers are
more likely to quit
Pneumonia Measures
Community Acquired Pneumonia
PN-1
Retired
PN-2
Pneumococcal vaccination*
Pneumococcal vaccination is indicated for
persons 65 years of age and older,
because it is up to 75% effective in
preventing pneumococcal bacteremia and
meningitis
Pneumonia Measures
PN-3a Blood cultures performed w/in 24
hours prior to or after arrival to the ICU
PN-3b- Blood cultures preformed in the ED
before the initial antibiotic
Published treatment guidelines recommend the
collection of blood cultures for all inpatients with
severe pneumonia to optimize therapy
Pneumonia Measures
PN-4 Smoking Cessation/counseling
Smoking cessation reduces mortality and
morbidity in all populations. Patients who
receive even brief smoking-cessation advice
from their care providers are more likely to
quit
Pneumonia Measures
PN-5a – 8 hours
PN-5b Initial antibiotic received within
4 hours of arrival
PN-5c - 6 hours
… clinical evidence of an association between
timely inpatient administration of antibiotics
and improved outcome among pneumonia
patients
Pneumonia Measures
PN-6 Initial antibiotic selection for CAP
PN 6a ICU patient
PN 6b Non- ICU patient
Pneumonia Measures
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PN-7
– Pneumonia patients age ≥ 50 y.o., hospitalized during
October, November, December, January, February or March
who were screened for influenza vaccine status and were
vaccinated prior to discharge, if indicated.
Surgical Care
Improvement Project
SCIP- Inf 1 Prophylactic Antibiotic Received
Within One Hour Prior to Surgical Incision
The risk of infection increases progressively with
greater time intervals between administration and
skin incision.
SCIP Measures
SCIP-Inf 2- Appropriate antibiotic selection
SCIP-Inf 3: Prophylactic antibiotic discontinued within
24 hours after surgery
SCIP-Inf 6: Appropriate hair removal
SCIP-Inf 7: Perioperative normothermia among
colorectal surgical patients
SCIP Measures
SCIP-Card-2 Surgery Patients on Beta
Blocker Therapy prior to admission
who received a Beta Blocker during
the perioperative period.
SCIP Pre-Op
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Document appropriate hair removal-do not
use the word shave or razor in the record
Document any DVT prevention measures
applied at this point (TED’s/SCD’s)
Antibiotic start w/in 60 min of incision
(120min for Vancomycin)
Beta Blocker received & documented during
peri-operative period if indicated
(Medication Reconciliation)
SCIP Measures
SCIP-VTE-1 Surgery Patients with
Recommended Venous
Thromboembolism Prophylaxis
Ordered
SCIP-VTE-2 Surgery Patients Who
Received Appropriate VTE Prophylaxis
Within 24 Hours Prior to Surgery to 24
Hours After Surgery
What can you do to help?
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Be a part of this successful process
Do not underestimate your impact on
patient outcomes
Teach – provide education to your patients
as you provide their care
Documentation – use the proper forms and
order sets
Talk to your peers and co-workers/make
core measures part of your daily vocabulary