1. Core Measures Evidence-Based Performance Measurement Lynne Hall, RN, BSN Green Belt Six Sigma Updated: 06/16/2011

2. Objectives  Be able to describe evidence-based medicine  Understand purpose of using Core Measures  Describe each Core Measure Set

3. What is Evidence-Based Medicine? Involves patient care that research has shown to result in better outcomes for patients such as lower: –Mortality and Morbidity –Disability –Length of stay –Readmissions These are also areas that CMS and Joint Commission focus on to make sure patients are receiving the right care at the right time!

4. What is a Core Measure? The percentage of eligible patients that receive care represented by the measure set –Example: Percent of eligible patients that receive aspirin on arrival for AMI

5. How do the two interact?  Evidence-based medicine was used in the development of core measures  Each question for each measure set was founded on evidence-based medicine principles by practicing physicians  Core measures are designed so that every patient is given the right care every time

6. What are the benefits of Core Measures?  Provides a measure of quality for your hospital  Assures the community that your hospital is providing high quality of care  Assures your hospital gets reimbursement from Medicare

7. What are the Core Measure Sets? Inpatient Clinical Areas of Focus are: –Heart Failure (HF) –Acute Myocardial Infarction (AMI) –Pneumonia (PN) –Surgical Care Infection Prevention (SCIP) –Venous Thromboembolism (VTE) –Stroke (STK) –Emergency Department (ED) –Prevention (Prev) –Children's Asthma Care (CAC)

8. What are the Core Measure Sets? Outpatient Clinical Areas of Focus are: –Chest Pain –AMI (designed for those patients who are transferred from the ED for a different level of care) –Outpatient Surgery –Radiology Imaging –Structural Measures

9. Heart Failure  HF-1: Discharge Instructions Given  HF-2: Evaluation of LVS Function  HF-3: ACEI / ARB Given for LVSD  HF-4: Adult smoking cessation advice/counseling given

10. AMI  AMI-1: Aspirin given on Arrival  AMI-2: Aspirin prescribed at discharge  AMI-3: ACEI / ARB for LVSD  AMI-4: Adult smoking cessation advice / counseling  AMI-5: Beta Blocker prescribed at discharge

11. AMI  AMI-7a: Fibrinolytic within 30 minutes of arrival  AMI-8a: Primary PCI received within 90 minutes of hospital arrival  AMI-9: Inpatient mortality  AMI-10: Statin Prescribed at Discharge

12. Pneumonia  PN-2: Pneumococcal Vaccination  PN-3a: Blood Cultures Performed Within 24 Hours Prior to or 24 Hours After Hospital Arrival for Patients Who Were Transferred or Admitted to the ICU Within 24 Hours of Hospital Arrival  PN-3b: Blood cultures performed in the ED prior to initial antibiotic received in hospital  PN-4: Adult smoking cessation advice / counseling

13. Pneumonia  PN-5c: Initial Antibiotic Received Within 6 Hours of Hospital Arrival  PN-6: Initial Antibiotic Selection for CAP in Immunocompetent Patient  PN-6a: Initial Antibiotic Selection for CAP in Immunocompetent – ICU Patient   PN-6b: Initial Antibiotic Selection for CAP Immunocompetent – Non ICU Patient  PN-7: Influenza Vaccination (October thru March)

14. SCIP (Surgical Care Improvement Project)  *SCIP-Inf-1: Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision  *SCIP-Inf-2: Prophylactic Antibiotic Selection for Surgical Patients  *SCIP-Inf-3: Prophylactic Antibiotics Discontinued Within 24 Hours After Surgery End Time  SCIP-Inf-4: Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Blood Glucose *The first three SCIP-Inf measures drill down into individual surgeries such as hips, knees, cardiac, etc

15. SCIP  SCIP-Inf-6: Surgery Patients with Appropriate Hair Removal.  SCIP-Inf-9: Urinary Catheter Removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) With Day of Surgery Being Day Zero.  SCIP-Inf-10: Surgery Patients with Perioperative Temperature Management.

16. SCIP  SCIP-Card-2: Surgery Pts on Beta-Blocker Therapy Prior to Admission Who Received a Beta-Blocker During the Perioperative Period  SCIP-VTE-1: Surgery Pts with Recommended VTE Prophylaxis Ordered  SCIP-VTE-2: Surgery Patients Who Received Appropriate VTE Within 24 Hours Prior to Surgery to 24 Hours After Surgery

17. Outpatient Measure Sets  OP-1: Median time to Fibrinolysis (AMI)  OP-2: Fibrinolytic therapy received within 30 min of hospital arrival (AMI)  OP-3: Median time to transfer to another facility for Acute Coronary Intervention (AMI)  OP-4: ASA on arrival (AMI / Chest Pain)  OP-5: Median Time to ECG (AMI / Chest Pain)

18. Outpatient Measure Sets  OP-6: Timing of Antibiotic Prophalaxis (Outpatient Surgery)  OP-7: Prophylactic Antibiotics selection for surgical patients (Outpatient Surgery)

19. Outpatient Measure Sets These measures are abstracted from Administrative Data Imagining Measures  OP-8: MRI Lumbar Spine for Low Back Pain  OP-9: Mammography Follow-up Rates  OP-10: Abdomen CT Use of Contrast Material  OP-11: Thorax CT Use of Contrast Material

20. Outpatient Measure Sets These measures are abstracted from Administrative Data Imagining Measures  OP-13 Cardiac Imaging for Preoperative Risk Assessment for Non Cardiac Low Risk Surgery  OP-14 Simultaneous Use of Brain Computed Tomography (CT) and Sinus Computed Tomography (CT)  OP-15 Use of Brain Computed Tomography (CT) in the Emergency Department for Atraumatic Headache

21. Outpatient Measure Sets These measures are abstracted from Administrative Data Structural Measures  OP-12 The Ability for Providers with HIT to Receive Laboratory Data Electronically Directly into their Electronic Health Record (EHR) System as Discrete Searchable Data  OP-17 Tracking Clinical Results Between Visits

22. What is the difference between a measure score and an ACM?

23. Measure vs. ACM Patient A Patient B Patient C Measure Total ASA on Arrival Yes No 2 of 3 or 67% ASA on D/C Yes 3 of 3 or 100% BB on D/C No 1 of 3 or 33% Yes Met ACM Total Yes No 1 of 3 or 33% ACM is All or nothing Measures are specific to that Measure

24. What can Physicians do to Help?  Communication with –Nurses –Family –Patient  Documentation, Documentation –This is not “cookbook” medicine but does involve documenting correctly on a Core Measure Patient Give yourself credit for the work you do! –Look for “triggers” that are placed on charts by staff that act as reminders for documentation

25. Examples  Example of unacceptable charting for “ASA at discharge” –“Hold ASA”  Example of ACCEPTABLE charting for “ASA at discharge” –“Hold EC ASA x 2 days” –“Hold aspirin until after endoscopy” Both of these imply the patient will start the ASA after a certain event or time frame

26. Summary  Evidence-based medicine helps provide the right care for every patient every time!  Core Measures help focus that effort  Know who is a core measure patient  Become familiar with which core measures your facility is using and what you can do to help!

27. Resources These resources give you the best insight into what evidence-based medicine is and how it effects your medical documentation and payment  www.qualitynet.org www.qualitynet.org  www.hospitalcompare.hhs.gov www.hospitalcompare.hhs.gov  www.qualitycheck.org www.qualitycheck.org

28. Questions?