Medical Error Tab Menu
State Comparison
Individual State
Performance Measure Tab Cardiac Registries Tab

 

ORGANIZATIONS BEHIND
    MEASUREMENT SETS

  NQF
  AHRQ
  CMS
  JCAHO
  NCQA
  AMA - PCPI
  AQA
  AHA
  SCIP
  IHI
  ACC
  STS
  Premier-CMS
  COAP


MEASUREMENT SETS
  AQA – AQA Measures
  AQA – Cardiac Surgery
  AQA – Cardiology
  CMS – HQA
  CMS – PVRP
  NQF – Cardiac Surgery
  Premier-CMS – HQI
  SCIP


PERFORMANCE MEASURES
    CROSSWALK BY TOPIC

  Patient Safety
  CABG / Cardiac Surgery
  PCI (angioplasty)
  ACS / AMI


PERFORMANCE MEASURE
    CODING

  HIPAA Standard Codes


 

Cardiac Surgery Measures

CABG - Specific Measures
Clinical Measure / Condition
NQF
AHRQ
Use of Arterial Grafts
IMA - excludes ‘redo’
    CABGs
X1
X
X
IMA - many exclusions
X
X
IMA + Other Artery
    options - no exclusions
X
Rx: Anti-platelet Therapy
ASA | clopidogrel @ d/c
X
X
ASA | Other drug @ d/c
X
X
X
Rx: β-blocker Therapy
<24h pre-CABG
X
X
X
<24h after CABG
X
Ordered at discharge2
X
X
X
X
Rx: Lipid-lowering Treatment
@ d/c2
X
X
X
@ d/c, if LDL >100 mg/dl
X
Lipid Therapy Following CABG
Cholesterol Management3
X
Intubation Times / Extubation
Time / Duration of Intubation
X
Extubation <24h after CABG
X
X
X
Extubation <6h after CABG
X
Complication - Return to OR
Hemorrhage | Hematoma
X
X
Return to OR, any reason
X
Re-exploration - cardiac
X
X
Complication - Sternal infection
Deep wound infection
X
X
Complication - Stroke
Stroke (Sxs >72h duration)
X
X
X
X
Complication - Renal Failure
ACCv3.0/STSv2.52 definition
X
X
X
New dialysis
X
Complication – Physiological Derangements
Physiologic/metabolic derangement
X
CABG Mortality (Self-reported5)
3M Risk-adj. In-Hospital4
X
X
NY Risk-adj. In-Hospital4
X1
X
Risk-adj. In-Hospital
    (NJ, PA, CA)4, 5
X
X
WA Risk-adj Inpatient4
X
STS Risk-adj. In-Hospital4
+/-
Risk-adj. 30-day (STS)4
X
X
+/-
CABG Surgery Volume6
>450/yr
X
>100/yr (ACC-AHRQ)
X
>200/yr (NY-AHRQ)
X
Actual CABG volume
X1, 7
X
X
CABG Utilization
Statewide per 100,000 pop
X
Area per 100,000 pop
X
Data Validation for compliance
Hospital Audit of CABG Cases
X
Valve and Valve+CABG 30-day Risk-Adjusted Mortality Measures
Clinical Measure / Condition
NQF
AHRQ
30-day Risk-adjusted Mortality (Self-reported )
AVR (STS)
X
MVR (STS)
X
AVR+CABG (STS)
X
MVR+CABG (STS)
X
General Patient Safety Measures Involving Cardiac Surgery
Clinical Measure / Condition
NQF
AHRQ
Database Participation
Participation in a Systematic
  Database for Cardiac Surg
X
X
X
Surgical Infection Prevention - Prophylactic Antibiotics (Ab)
Ab Administered
X
X
X
X
X
Ab Timing <1h pre-incision
X
X
X
X
X
Ab Duration 24 to <48h from surg
X
X
X
X
X
Ab Choice/process appropriate
X
Events After elective surgery
Postop Sepsis, if LOS >3d
X
Physiologic/metabolic derangement
X
Respiratory Failure
X
Events During any surgery
Anesthesia complication
X
Accidental Retained Foreign Body Accidental
X
Accidental Puncture / Laceration
X
Wrong Surgery Patient
X
Wrong Surgery Site
X
Events After any surgery
Selected Infections Due to Medical Care
X
PostOp Hemorrhage or Hematoma
X
Hip Fracture (in-hospital)
X
Pulmonary Embolism
X
Deep Vein Thrombosis
X
Failure to Rescue (<75yo, etc.)
X

1  Performance measure for AMI / ACS - Not a primary measure for CABG.

2  Definitions include varying numbers of exclusions / ‘contra-indications.’ NQF definitions have no exclusions whereas other definitions include exclusionary criteria.

3  Cholesterol Management in patients with cardiovasuclar conditions includes the percentage of CABG patients who had a low-density lipoprotein cholesterol (LDL-C) screening performed and the percentage of patients who have a documented LDL-C level less than 130 mg/dL and less than 100 mg/dL.

4  CABG mortalilty risk models vary. NQF Standards for Hospital Care uses NY State Cardiac Surgery Reporting System's logistic regression model, while NQF Standards for Cardiac Surgery uses the California CCORP model for inpatient mortality, and COAP (Washington State) uses its own risk model. Premier CMS uses 3M™ Risk adjusted - All Patient Refined DRG methodology. AHRQ IQI uses JCAHO APR-DRG risk-stratification methodology.

The Leapfrog Group assigns a quartile mortality performance based upon self-reported data from either the "Leapfrog Survey" or STS performance of ‘worse than national average’ or ‘better than national average.’ The risk-adjustment follows the appropriate Leapfrog-approved State statistical model (NY, NJ, PA, CA) or the STS model, (although Leapfrog does not stipulate whether hospitals use the STS inpatient or STS 30-day operative mortality standard for this self-reported information). Based on either source, this binary disposition accounts for 34% of the scoring per Leapfrog's methodology. Because of this adjustment, a hospital's placement in a Leapfrog quartile does not convey whether its risk-adjusted mortality rate is statistically significantly different from (a) the statewide average, or (b) another hospital in its quartile, or (c) another hospital in a different quartile.

5  New Jersey and Pennsylvania actually validate 30-day mortality in the state database, whereas all other mortality rates are self-reported by facility.

6  AHRQ and the NQF Cardiac Surgery measures use volume based on administrative data reports; COAP and The Leapfrog Group rely upon self-reported volumes.

7  The NQF Hospital Measures endorsed CABG-volume according to NY State definition.

*  On June 16, 2006, the AQA Alliance adopted a subset of 15 of the NQF's 21 National Voluntary Consensus Standards for Cardiac Surgery as a "starter set" of performance measures [See Announcement – Word .Doc].

©QuPS.org   Terms of Use
©QuPS.org   Privacy Policy