Hospital Core Clinical Data Elements for Acute Myocardial Infarction (AMI)

This is not an electronic clinical quality measure. This logic is intended to extract electronic clinical data elements for all Medicare fee-for-service beneficiaries over the age of 65 years admitted for treatment of acute myocardial infarction (AMI). Specifically, it is designed to extract the first captured set of vital signs (heart rate and systolic blood pressure) and laboratory results (creatinine and Troponin) in this subset of patients hospitalized for AMI. These data will be linked with administrative claims data to risk adjust the hospital 30-day risk-standardized acute myocardial infarction (AMI) mortality hybrid measure.

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CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.

These performance specifications are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND.

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Although we are using the "proportion" function in the MAT, hospitals will not report a proportion, ratio, or rate. Instead, hospitals will report actual data values for the elements included. 

The intent of this logic is to extract the FIRST value for heart rate, systolic blood pressure, creatinine, and troponin  on patients from hospital EHRs, and to use the data along with a patient's age to risk adjust the hospital 30-day risk-standardized acute myocardial infarction (AMI) mortality hybrid measure (NQF# 2473). This work addresses stakeholder concerns that clinical data garnered from patients, and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data. We are calling the list of data elements for extraction the "AMI-specific core clinical data elements". These AMI-specific core clinical data elements are the first set of vital signs and basic laboratory test results captured on adult Medicare fee-for-service patients, age 65 or older, after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values is often captured in the emergency department or sometimes in the pre-operative area hours before a patient is admitted to that same facility. 

These data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital; 2. are clinically and statistically relevant to patient outcomes; 3. are consistently obtained on adult inpatients based on current clinical practice; 4. are captured with a standard definition and recorded in a standard format across providers; and 5. are entered in structured fields that are feasibly retrieved from current EHR systems. The AMI-specific core clinical data elements also include some demographic data (such as age and sex). Age is used in the measure's risk model. Other demographic data listed in the Supplemental Data Elements field are used to link EHR data files with administrative claims data for CMS to calculate results for the measure.

The logic is not meant to guide or alter the care patients receive. The purpose of this logic is to extract clinical data that are already routinely captured in EHRs among hospitalized adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.

No actual measure score will be generated by hospitals. Instead, hospitals will report the data values for each of the AMI-specific core clinical data elements for all patients in the denominator. These AMI-specific core clinical data elements will be linked to administrative claims data and used by CMS to calculate results for the hospital 30-day risk-standardized acute myocardial infarction (AMI) mortality hybrid measure.

Core Clinical Data Elements for AMI

This logic guides the user to extract the FIRST captured AMI-specific core clinical data elements for all Medicare fee-for-service patients age 65 or older, (as described by Initial Population field) directly admitted to the hospital or admitted to the same facility after an emergency department stay or surgical procedure for treatment of AMI. 

The logic supports extraction of the FIRST set of AMI-specific core clinical data elements in two different ways, depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the Emergency Department or other outpatient location within the same admitting facility: 

1. If the patient was a direct admission, the logic supports extraction of the FIRST captured vital signs within 2 hours after the start of the inpatient admission, and the FIRST captured laboratory test results within 24 hours after the start of the inpatient admission. 
2. If the patient has values captured prior to admission within the same admitting facility, for example from the emergency department or pre-operative or other outpatient area within the hospital, the logic supports extraction of the FIRST captured vital signs and laboratory test results within 24 hours PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for AMI-specific core clinical data element values related to a patient who is initially treated in an outpatient location within the hospital and then subsequently admitted to the same facility for AMI.

NOTE: Do not report ALL values on a patient during their entire admission.  Only report the FIRST recorded value for EACH AMI-specific core clinical data element collected in the appropriate timeframe, if available.

For each patient please also report:
Patient date of birth
Medicare Health Insurance Claim (HIC) number
Date of admission
Date of discharge
Your facility's CMS Certification Number (CCN)

These additional data elements will be included in the Excel file format for reporting in Performance Year 1.

Excel format provided

All Medicare fee-for-service patients age 65 and older with an inpatient admission (length of stay <365 days) and a principal diagnosis of acute myocardial infarction (AMI) during the measurement period.

Same as initial population

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For patients in the denominator, report the FIRST value for vital signs (heart rate and systolic blood pressure) captured within the 24 hours prior to the inpatient admission. If no values were captured in the 24 hours prior to the admission (for example, for patients directly admitted to the hospital) report the first value captured within 2 hours after the start of the inpatient admission. For laboratory test results (creatinine, Troponin), report the first captured value in the 24 hours prior to admission. If there are no values in the 24 hours prior to admission, report the first values within 24 hours after the start of the inpatient admission. First values for the following data elements may be captured in the emergency department or other outpatient area within the hospital before a patient is subsequently admitted to the same hospital. First values for these data elements may also be captured on an inpatient unit for directly admitted patients who do not receive care in the emergency department or other hospital outpatient location before admission. 

The AMI-specific core clinical data elements are as follows:
Age
Heart rate
Systolic blood pressure
Creatinine
Troponin level

NOTE: Do not report ALL values on a patient during their entire admission. Only report the FIRST recorded value for EACH AMI-specific core clinical data element collected in the appropriate timeframe, if available

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex.