Aspirin Prescribed at Discharge

Measure specifications are in the Public Domain. LOINC (R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.

Aspirin therapy in patients who have suffered an acute myocardial infarction reduces the risk of adverse events and mortality. Studies have demonstrated that aspirin can reduce this risk by 20% (Antiplatelet Trialists' Collaboration, 1994). National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI (Antman, 2004; Antman, 2008; Anderson, 2007; and Smith, 2006).

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1–157.

Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy - I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81-106.

Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. 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.

Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 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 (Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;51:210–47.

Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046 –99.

Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. J Am Coll Cardiol. 2006;47:2130 –9. doi:10.1016/j.jacc.2006.04.026.

The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec. Exclusion element guidance: The intent for the exclusion for patients who are clinical trial participants was to be limited to patients participating in a clinical trial for acute myocardial infarction (AMI), ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (non-STEMI), heart attack, or acute coronary syndrome (ACS), the same conditions as covered by the measure. However, the value set specifying clinical trial participation is not limited to a specific type of trial; therefore, this piece of logic will not be included in certification testing or reviewed on audit at this time.

Patients with Comfort Measures Only documented. Patients enrolled in clinical trials. Patients discharged to another hospital. Patients who left against medical advice. Patients who expired. Patients discharged to home for hospice care. Patients discharged to a health care facility for hospice care. Patients with a documented Reason for No Aspirin at Discharge

Table of Contents

Initial Patient Population =
- AND: "Diagnosis, Active: Hospital Measures - AMI (ordinality: 'Hospital Measures - Principal')" starts during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
- AND: "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient (length of stay <= 120 day(s))"
- AND: "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient (discharge datetime)" during "Measurement Period"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- AND:
  - OR: "Intervention, Performed: Hospital Measures-Comfort Measures Only Intervention" starts during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Medication, Adverse Effects: Aspirin Allergen" starts before or during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient (discharge status: 'Hospital Measures - Expired')"
  - OR: "Medication, Discharge not done: Medical Reason" for "Hospital Measures-Aspirin RxNorm Value Set" during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Medication, Order not done: Medical Reason" for "Hospital Measures-Aspirin RxNorm Value Set" during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Medication, Order not done: Patient Reason" for "Hospital Measures-Aspirin RxNorm Value Set" during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Medication, Discharge: Hospital Measures - Warfarin Anticoagulants" during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Medication, Administered not done: Hospital Measures - Hold" for "Hospital Measures-Aspirin RxNorm Value Set" during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Medication, Allergy: Aspirin Allergen" starts before or during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Medication, Intolerance: Aspirin Allergen" starts before or during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient (discharge status: 'Discharge To Another Hospital')"
  - OR: "Medication, Discharge not done: Patient Reason" for "Hospital Measures-Aspirin RxNorm Value Set" during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Transfer To: Hospital Measures - Home Hospice Care" < 1 day(s) starts after end of "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Transfer To: Hospital Measures - Inpatient Hospice Care" < 1 day(s) starts after end of "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
  - OR: "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient (discharge status: 'Left Against Medical Advice')"
  - OR:
    - AND NOT: "Occurrence A of Patient Characteristic: Clinical Trial Participant" ends before start of "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
    - AND: "Occurrence A of Patient Characteristic: Clinical Trial Participant" starts before or during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
Numerator =
- AND: "Medication, Discharge: Hospital Measures-Aspirin" starts during "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
Denominator Exceptions =
- None

"Diagnosis, Active: Hospital Measures - AMI" using "Hospital Measures - AMI Grouping Value Set (2.16.840.1.113883.3.666.5.3011)"
"Encounter, Performed: Hospital Measures-Encounter Inpatient" using "Hospital Measures-Encounter Inpatient SNOMED-CT Value Set (2.16.840.1.113883.3.666.5.625)"
"Intervention, Performed: Hospital Measures-Comfort Measures Only Intervention" using "Hospital Measures-Comfort Measures Only Intervention SNOMED-CT Value Set (1.3.6.1.4.1.33895.1.3.0.45)"
"Medication, Administered not done: Hospital Measures - Hold" using "Hospital Measures - Hold SNOMED-CT Value Set (2.16.840.1.113883.3.666.5.1145)"
"Medication, Administered: Hospital Measures-Aspirin" using "Hospital Measures-Aspirin RxNorm Value Set (2.16.840.1.113883.3.666.5.626)"
"Medication, Adverse Effects: Aspirin Allergen" using "Aspirin Allergen RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.139)"
"Medication, Allergy: Aspirin Allergen" using "Aspirin Allergen RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.139)"
"Medication, Discharge not done: Medical Reason" using "Medical Reason SNOMED-CT Value Set (2.16.840.1.113883.3.526.2.313)"
"Medication, Discharge not done: Patient Reason" using "Patient Reason SNOMED-CT Value Set (2.16.840.1.113883.3.526.2.311)"
"Medication, Discharge: Hospital Measures - Warfarin Anticoagulants" using "Hospital Measures - Warfarin Anticoagulants RxNorm Value Set (2.16.840.1.113883.3.666.5.636)"
"Medication, Discharge: Hospital Measures-Aspirin" using "Hospital Measures-Aspirin RxNorm Value Set (2.16.840.1.113883.3.666.5.626)"
"Medication, Intolerance: Aspirin Allergen" using "Aspirin Allergen RxNorm Value Set (2.16.840.1.113883.3.117.1.7.1.139)"
"Medication, Order not done: Medical Reason" using "Medical Reason SNOMED-CT Value Set (2.16.840.1.113883.3.526.2.313)"
"Medication, Order not done: Patient Reason" using "Patient Reason SNOMED-CT Value Set (2.16.840.1.113883.3.526.2.311)"
"Medication, Order: Hospital Measures-Aspirin" using "Hospital Measures-Aspirin RxNorm Value Set (2.16.840.1.113883.3.666.5.626)"
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
"Patient Characteristic: Clinical Trial Participant" using "Clinical Trial Participant SNOMED-CT Value Set (2.16.840.1.113883.3.526.2.643)"
"Transfer To: Hospital Measures - Home Hospice Care" using "Hospital Measures - Home Hospice Care SNOMED-CT Value Set (2.16.840.1.113883.3.666.5.3008)"
"Transfer To: Hospital Measures - Inpatient Hospice Care" using "Hospital Measures - Inpatient Hospice Care SNOMED-CT Value Set (2.16.840.1.113883.3.666.5.3007)"
Attribute: "Ordinality: Hospital Measures - Principal" using "Hospital Measures - Principal SNOMED-CT Value Set (2.16.840.1.113883.3.666.5.3010)"
Attribute: "Discharge status: Hospital Measures - Expired" using "Hospital Measures - Expired Grouping Value Set (2.16.840.1.113883.3.666.5.1146)"
Attribute: "Discharge status: Discharge To Another Hospital" using "Discharge To Another Hospital SNOMED-CT Value Set (2.16.840.1.113883.3.117.1.7.1.87)"
Attribute: "Discharge status: Left Against Medical Advice" using "Left Against Medical Advice SNOMED-CT Value Set (2.16.840.1.113883.3.666.5.1106)"

None

"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex Administrative Sex Value Set (2.16.840.1.113762.1.4.1)"

Measure Set

Acute Myocardial Infarction (AMI)

eMeasure Title	Aspirin Prescribed at Discharge
eMeasure Identifier (Measure Authoring Tool)	100	eMeasure Version number	2
NQF Number	0142	GUID	bb481284-30dd-4383-928c-82385bbf1b17
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	Oklahoma Foundation for Medical Quality
Measure Developer	Oklahoma Foundation for Medical Quality
Endorsed By	National Quality Forum
Description	Acute myocardial infarction (AMI) patients who are prescribed aspirin at hospital discharge
Copyright	Measure specifications are in the Public Domain. LOINC (R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer	None
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Aspirin therapy in patients who have suffered an acute myocardial infarction reduces the risk of adverse events and mortality. Studies have demonstrated that aspirin can reduce this risk by 20% (Antiplatelet Trialists' Collaboration, 1994). National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI (Antman, 2004; Antman, 2008; Anderson, 2007; and Smith, 2006).
Clinical Recommendation Statement	National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI
Improvement Notation	Higher score indicates better quality
Reference	Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1–157.
Reference	Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy - I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81-106.
Reference	Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. 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.
Reference	Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 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 (Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;51:210–47.
Reference	Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046 –99.
Reference	Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. J Am Coll Cardiol. 2006;47:2130 –9. doi:10.1016/j.jacc.2006.04.026.
Definition	None
Guidance	The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec. Exclusion element guidance: The intent for the exclusion for patients who are clinical trial participants was to be limited to patients participating in a clinical trial for acute myocardial infarction (AMI), ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (non-STEMI), heart attack, or acute coronary syndrome (ACS), the same conditions as covered by the measure. However, the value set specifying clinical trial participation is not limited to a specific type of trial; therefore, this piece of logic will not be included in certification testing or reviewed on audit at this time.
Transmission Format	None
Initial Patient Population	All hospital discharges for acute myocardial infarction (AMI) with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission
Denominator	All Acute Myocardial Infarctions patients age 18 and older with an ICD-9-CM Principal Diagnosis Code for Acute Myocardial Infarction
Denominator Exclusions	Patients with Comfort Measures Only documented. Patients enrolled in clinical trials. Patients discharged to another hospital. Patients who left against medical advice. Patients who expired. Patients discharged to home for hospice care. Patients discharged to a health care facility for hospice care. Patients with a documented Reason for No Aspirin at Discharge
Numerator	Acute Myocardial Infarction patients who are prescribed aspirin at hospital discharge.
Numerator Exclusions	None
Denominator Exceptions	None
Measure Population	Not applicable
Measure Observations	Not applicable
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity, and sex.

Table of Contents

Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements