Core Measures New- Final

8/3/2019 Core Measures New- Final

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What is a core measure?

These are a set of care processes, which were developed

by The Joint Commission, the nation's predominantstandards-setting and accrediting body in health care, to

improve the quality of health care by implementing a

national, standardized performance measurement system.


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* The Core Measures were derived largely from a set of quality

indicators defined by the Centers for Medicare and Medicaid Services(CMS).

* They have been shown to reduce the risk of complications,prevent

recurrencesand otherwise treat the majority of patients who come to a

hospital for treatment of a condition or illness.

* Core Measures help hospitals improve the quality of patient care by

focusing on the actual results of care.


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WHY DO WE HAVE TO WORRY ?

#1 Reason: The PATIENT

It isnt just about the numbers.

it is about the right care every time.


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Other reasons to improve core measure rates Assure our community and our Board of

Directors that we are providing high quality

care.

Receive higher reimbursement from Medicareand other payers.


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Backgound:

The Joint Commission began development of performance measureswith the inception of the Agenda for Change in 1987. Eventuallythese activities were subsumed into what became called the ORYXinitiative.

The initial phase of the ORYX initiative offered health careorganizations significant flexibility. Organizations could meetaccreditation requirements by selecting from among literally hundredsof performance measurement systems and thousands of performancemeasures that best served their strategic measurement goals.

The flexibility made available through the initial phases of the ORYXinitiative also presented certain challenges. Most notable was theinability to compare health care organization data across systems andbetween disparate measures.


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The next phase of the ORYX initiative was intended to address this challengethrough the use of standardized, evidence based measures.

In 1999, the Joint Commission sought input from a variety of stakeholders

including clinical professionals, hospitals, consumers, state hospitalassociations and medical societies about potential focus areas for an initial setof hospital core measures.

Once focus areas were identified, advisory panels were convened to identify

measures that, when viewed together, permitted a robust assessment of thecare provided in a given focus area.


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The input of these stakeholders, together with recommendations from state

hospital associations led to the identification of five initial core measurementareas:

Acute myocardial infarction

Heart Failure

Community acquired pneumonia

Pregnancy and related conditions (including newborn and maternal care)

Surgical procedures and complications

A period of extensive work involving clinical input from expert panels,attributes and evaluation criteria for core performance measures developedwith an Advisory Council on Performance Measurement and pilot testing withstate hospital associations, measurement systems, and hospitals led to the finalselection of hospital core measures.

Implementation of data collection on the first sets of ORYX core measuresfor hospitals began in July 2001.


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They also contributed to the postponement of implementation for the SurgicalProcedures and Complications core measure set.

Stakeholder comments and additional research indicated that consensus amongthe major professional organizations and stakeholder groups in this area waslacking in this area. Therefore, development of the Surgical Procedures andComplications core measure set was delayed until consensus could be reached.


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Principles Respecting Joint Commission Core PerformanceMeasurement Activities

Preamble

The Joint Commissions primary mission is to improve the quality of careprovided to the public through the provision of health care accreditationand related services that support performance improvement in health careorganizations.

Performance measurement is a critical link between accreditation and theprocesses and outcomes of patient care, allowing the Joint Commission toreview data trends and patterns, and work collaboratively withorganizations as they use data to improve health care quality, improvepatient outcomes and reduce associated costs


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The principles

(1) fit with existing health care organization approaches to performanceimprovement;

(2) are consistent with the Joint Commission mission;

(3) meet the needs of disparate users;

(4) identify individual measures that adhere to established criteria and aresupported by the highest possible level of clinical evidence ;

(5) result in appropriately disseminated measurement data;

(6) are coordinated with other national measurement-related efforts;

(7) are cost effective and support waste reduction;

(8) do not place undue burden on health care organizations, and;(9) are based upon data that are accurate and complete.


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Acute Myocardial Infarction (AMI):

The literature supports theimportance of measuring theprocesses and outcomes ofcare for patients with AMI

based primarily on diseaseprevalence.

Currently, cardiovasculardisease, including AMI, is

the leading cause of death inthe United States

.


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Each year 900,000 people inthe United States are diagnosed

with AMI; of these,approximately 225,000 casesresult in death and, it isestimated that an additional125,000 patients die beforeobtaining medical care.

The scope of the AMI coremeasure set was limited topatients 18 years of age and

older because the clinicaltreatment of younger patients issubstantially different


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Hospital AMI Core Measures:

1) Aspirin within 24hrs of arrival or on discharge:

Aspirin therapy in patients who have suffered an acute

myocardial infarction reduces the risk of adverse events and

mortality.

Studies have demonstrated thataspirin can reduce this risk by

20% (Antiplatelet Trialists' Collaboration, 1994).


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2) Use of beta blocker within 24 hours of admission or on discharge:


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2) Use of beta blocker within 24 hours of admission or on discharge:

Beta blocker therapy REDUCES both the degree of infarction

and incidence of complications in patients not receiving

concomitant thrombolytic therapy, and the incidence ofreinfarction in patients who receive thrombolytic therapy

Long-term beta blocker therapy DECREASES mortality byreducing the incidence of sudden and nonsudden cardiac

death.


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3) Presence of ST elevation or LBBB on arrival EKG

4) Timing of thrombolysis

5) Timing of angioplasty


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The timing of reperfusion is critical to the effective management of AMI

patients and the earlier therapy is initiated, the betterthe outcome.


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The timing of reperfusion is critical to the effective management of AMIpatients and the earlier therapy is initiated, the betterthe outcome.

Patients presenting with AMI and ST segment elevation or left bundlebranch block (LBBB) are at a relatively high risk of death. This riskmay be reduced by thrombolytic therapy or PTCA, but only ifadministered/performed in a timely manner


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The timing of reperfusion is critical to the effective management of AMIpatients and the earlier therapy is initiated, the betterthe outcome.

Patients presenting with AMI and ST segment elevation or left bundlebranch block (LBBB) are at a relatively high risk of death. This riskmay be reduced by thrombolytic therapy or PTCA, but only ifadministered/performed in a timely manner

The greatest benefits of thrombolytic therapy are evident in the first 3hours after the onset of symptoms, but there is proven benefit for up to12 hours after the onset of symptoms.


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6) Use of ACEI/ARB :


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6) Use of ACEI/ARB :

Clinical trials have established that the using ACEI for patientsdiagnosed with HF can

Alleviate symptoms,

Improve clinical status,

Enhance overall sense of well-being,

Can reduce the riskof death and hospitalization.


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7)Smoking Cessation counseling :


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7)Smoking Cessation counseling :

Each year, more than 430,000 deaths in the United States are

attributed to a smoking related illness.

Smoking Triggers coronary spasm,

Reduces the anti-ischemic effects of beta blockers,

Increases mortality after AMI.

Evidence indicates that within one year of quitting smoking, a

patient's risk of acute myocardial Reinfarction and AMI mortality is

reduced.

Between 30-50% of AMI patients begin smoking again within 6 to 12months of their diagnosis.


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8) Hypolipidemic therapy on discharge:


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8) Hypolipidemic therapy on discharge:

Statin therapy provides effective reduction of LDL-cholesterol, which

represents the primary therapeutic goal of lipid-lowering therapy in

patients at risk for cardiovascular disease.

Fibrate therapy may represent an alternative for those with low HDL-

cholesterol and high triglyceride levels.


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HEART FAILURE

Heart failure (HF) was identified by key Joint Commissionstakeholders as one of the initial priority focus areas forhospital core measure development.

The literature supports the importance of measuring theprocesses and outcomes of care for patients with HFprimarily based on disease prevalence.

Nearly 5 million patients in the U.S. have HF, andapproximately 500,000 to 900,000 new cases arediagnosed each year.


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Heart failure is the most common Medicare diagnosis-

related group, and more Medicare dollars are spent for thediagnosis and treatment of HF than for any other diagnosis.

The scope of the HF core measure set is limited to patients

18 years of age and older because the clinical treatment of

younger patients is handled substantially differently


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1. HF Discharge instructions

Educating patients with heart failure and their families is critical.Patient non-compliance with physician's instructions is often a cause ofre-hospitalization.

It is thus important that health care professionals ensure that patientsand their families:

a. Understand the prognosis of heart failure,b. The rationale for pharmacotherapy & prescribed medication regimen,c. Dietary restrictions,

d. Activity recommendations,

e. The signs and symptoms of deteriorating condition.

Additionally, patients discharged from the hospital after anexacerbation of heart failure should have follow-up to ensure clinicalstability.


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2. LVF assessment

Measurement of left ventricular performance is a critical step in theevaluation and management of almost all patients with suspected orclinically evident heart failure.

The combined use of history, physical examination, chest x-ray, andelectrocardiography cannot reliably distinguish between the majorcategories of HF: Left ventricular systolic dysfunction,

Left ventricular diastolic dysfunction, or

Non-cardiac etiology.

If measurement of ventricular performance is not obtained in patientspresenting with heart failure, appropriate treatment may be withheld.

Specifically, patients with left ventricular systolic dysfunction will notbe identified and, therefore, will not be treated with agents known toprolong life.


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3.Angiotensin Converting Enzyme Inhibitors:

Clinical trials have established that the using ACEI for patientsdiagnosed with HF can

Alleviate symptoms

Improve clinical status

Enhance overall sense of well-being

Can reduce the risk of death and hospitalization.


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4. Beta Blocker on Discharge

5. Smoking Cessation Counseling


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PNEUMONIA

In the United States, pneumonia is the sixth most commoncause of death.

Much of the increase is due to a greater population of

persons aged 65 years or older, and a changingepidemiology of pneumonia, including a greater proportionof the population with underlying medical conditions atincreased risk of respiratory infection.

Annually, 2-3 million cases of community acquiredpneumonia (CAP) result in 10 million physician visits;500,000 hospitalizations; and 45,000 deaths.


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1. Oxygenation assessment within 24 hours of hospital arrival

This measure allows for an oxygenation assessment using eitherpulse oximetry or arterial blood gas as the diagnostic tool.


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2. Blood cultures obtained prior to first antibiotic administration

The requirement for blood cultures for all hospitalized CAP patients remains acontroversial issue.

Although there is consensus that blood cultures prior to antibiotics is goodpractice, there was not sufficiently compelling evidence to infer, through theuse of a core measure, that all CAP patients have a blood culture obtained.

A guiding principle in the selection of the Joint Commission core measures is

that the measures be evidence-based.

While there is now emerging evidence in the literature to support bloodcultures for all hospitalized CAP patients, the Joint Commission had taken aconservative approach in the selection of a blood culture core measure in orderto promote cost effective care and reduce the data collection burden.

This measure was selected in October 1999.


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3.Time from initial hospital arrival to first dose of antibiotic

Data strongly support the timing of antibiotics as an important factor inreducing mortality in CAP.

The data further suggests that positive effects were seen withadministration of antibiotics as early as 4 to 8 hours after admission.

Recent studies completed by the Centers for Medicare and MedicaidServices indicate administration of antibiotics to patients withpneumonia within 4 hours of hospital arrival is associated withimproved in-hospital and 30-day mortality.

This has prompted CMS to change their proportion measure to

identify patients who received their initial antibiotic within 4 hours ofhospital arrival instead of the previous measure that looked at 8 hours.


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4. Pneumonia Vaccination screening and vaccination:

Pneumococcal screening and vaccination is a very important nationalhealth issue that transcends the pneumonia diagnosis and measure set.

Streptococcus pneumoniae is among the leading infectious causes ofillness and death worldwide for young children, persons who haveunderlying chronic systemic conditions, and in the elderly.

It accounts for two-thirds of over 7,000 cases in which an etiologicdiagnosis was made, and for two-thirds of the cases of lethalpneumonia.

It is estimated that 125,000 cases of Pneumococcal pneumonianecessitate hospitalization each year.

According to guidelines of the Advisory Council on ImmunizationPractices of the Centers for Disease Control and Prevention (CDC), themajor preventive measures for CAP are use of influenza andpneumococcal vaccines.


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5. Smoking Cessation:

Smoking damages the lungs defenses against respiratory

infections.

Patients who quit smoking are less likely to get pneumonia

again.

Patients who receive even brief advice about quitting smoking

from their health care providers are more likely to quit than

those who receive no advice or counseling.


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6. Other Factors which help in deciding the Antibiotics:

HIV/ AIDS, Chemotherapy/ Immunosuppressive therapy

Radiation Therapy in past 3 months

Leukemia / Lymphoma diagnosed in the past 3 months

Prior Hospitalization in the past 14 days

Admitted to ICU in 24hrs

If YES, whether at risk of Pseudomonas

Allergies : Penicillin, Beta Lactams


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Performance Improvement ProjectOn

Core Measures

BY

DR KENNETH AFENYA

DR PRAVEEN JINNUR

DR OLOYEDE OLALOWO

DR KHURRAM LIAQUAT

APRIL 2009


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The main aim of the project is to improve the overall data

regarding CORE MEASURES at THE BROOKLYN HOSPITALCENTER.


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1)To constantly remind residents of potential patients who require coremeasures.

2)To ensure that residents sign-off sheet is modified to include checkboxes for all the various component of the core measure.

3)To collaborate with the case managers of the individual floors and

units to put reminder tags on the chart requiring core measures.

4)To ensure continuous and consistent process that will stimulate andsupport a significant improvement in the quality of hospital care.

5)To organized several educational forums that will emphasized the

significant of core measures.

6)To ultimately fulfill the national safety goals.

7)To ascertain the actual causes of the decline in compliant to coremeasures.


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The teams main task is to monitor the patients with potentialrequirement for core measure and notify the respective residents takingcare of those patient prior to their discharge.

The effort is to ensure we deliver adequate quality care withoutcompromising on mere oversight. The teams works in collaborationwith the case manager on each floor or unit to augment the need toexecute these measures in timely fashion pending discharge.

The team meets once a week to evaluate the weeks activity andanalyze the data collected. Each individual is assigned a particular floor

to avoid duplication of effort.

The team organizes periodic teaching and reminder session to makesure all residents conform to the necessary requirement.


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7B RESULTS FOR WEEK 1

PNEUMONI

A

CHF

MI

PNEUMONIA

CHF

MI

7B RESULTS FOR WEEK 2

PNEUMONI

ACHF

MI

PNEUMONIA

CHF

MI


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7W RESULTS FOR WEEK1

PNEUMONI

A

CHF

MI

PNEUMONIA

CHF

MI

7W RESULTS FOR WEEK 2

PNEUMONI

ACHF

MI

PNEUMONIA

CHF

MI


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8B RESULTS WEEK 1

PNEUMONI

A

30%

CHF

66%

MI

4%

PNEUMONIA

CHF

MI

8B RESULTS IN WEEK 2

PNEUMONI

A

18%

CHF

82%

MI

0%

PNEUMONIA

CHF

MI


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CSCU RESULTS FOR WEEK 1

PNEUMONI

A

6%

CHF

77%

MI

17%

PNEUMONIA

CHF

MI

CSCU RESULTS FOR WEEK 2

PNEUMONI

A

18%

CHF

70%

MI

12%

PNEUMONIA

CHF

MI


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MICU RESULTS FOR WEEK 1

PNEUMONI

A

57%

CHF

43%

MI

0%

PNEUMONIA

CHF

MI

MICU RESULTS FOR WEEK 2

PNEUMONI

A

29%

CHF

71%

MI

0%

PNEUMONIA

CHF

MI


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Core Measures New- Final

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