Introduction to Core Measures

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IntroductiontoCore Measures

• Lynn Benson
• Preferred Nurse Staffing

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Core Measures

• Who is information reported to?
• JCAHO
• CMS
• National Patient Safety Foundation

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ACM Measures

• 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 ten-measures
   (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.

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Core Measures

• Public has access to quality information through
  the Internet
• How does Riley Hospital measure up??
• Check it out at http//www.hospitalcompare.hhs.gov
  

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Core Measures

• 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

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Inpatient Core Measure Groups

• Acute Myocardial Infarction (AMI)
• Congestive Heart Failure (HF)
• Pneumonia (PN)
• Surgical Care Improvement Project (SCIP)
• Childhood Asthma Prevention

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Core Measures

• 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

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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

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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

10
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

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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

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AMI Measures

• AMI-6 Beta Blocker at arrival
• RETIRED

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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

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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

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Heart Failure Measures

• HF 1 Discharge Instructions
• 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

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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)

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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

18
Heart Failure Measures

• HF-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

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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

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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

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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

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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

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Pneumonia Measures

• PN-6 Initial antibiotic selection for CAP
• PN 6a ICU patient
• PN 6b Non- ICU patient

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Pneumonia Measures

• 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.

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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.

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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

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SCIP Measures

• SCIP-Card-2 Surgery Patients on Beta Blocker
  Therapy prior to admission who received a Beta
  Blocker during the perioperative period.

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SCIP Pre-Op

• Document appropriate hair removal-do not use the
  word shave or razor in the record
• Document any DVT prevention measures applied at
  this point (TEDs/SCDs)
• Antibiotic start w/in 60 min of incision (120min
  for Vancomycin)
• Beta Blocker received documented during
  peri-operative period if indicated (Medication
  Reconciliation)

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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

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What can you do to help?

• 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