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Core Options Review

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Timeframe for October release notes. Review general program changes ... VTE Laparoscope. VTE Prophylaxis. VTE Timely. Revised data elements. Surgical incision time ... – PowerPoint PPT presentation

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Title: Core Options Review


1
Core Options Review
  • Changes effective with October 1, 2006 discharges

2
Agenda
  • Timeframe for October release notes
  • Review general program changes
  • Brief overview of October 2006 discharges
  • General abstraction changes
  • SCIP
  • PN
  • Review of July discharges
  • SIP to SCIP Transition
  • Sampling

3
Timeframe
  • Beta sites currently reviewing tool
  • Want to join
  • You must be ready to abstract October discharges
  • You must be able to get automatic updates
  • If you are part of a multi-hospital system all
    facilities must agree to participate
  • General release scheduled for October 26th
  • Third Quarter data due December 15th
  • Fourth Quarter data due March 15th

4
General Abstraction
  • Demographic
  • Patient HIC
  • Change valid length to 7-12 characters
  • Suggested Data Sources
  • Form Locators for some data elements may change
    with the implementation of the UB-04

5
Unknown and Missing Data Elements
  • Unknown times
  • Antibiotic and blood culture times
  • Leave empty and Core Options will populate with
    9999 during transmission to the QNET Warehouse
  • Miscellaneous data elements
  • Temperature Value, Glucose POD 1 and Glucose POD
    2
  • Use 9999 to indicate that the value was not
    recorded

6
Discharge Instruction - HF
  • Applies to all 6 discharge instruction questions
  • Clarification on use of electronically formatted
    media such as videos, CDs, and DVDs
  • Use only the documentation provided in the
    medical record itself. If literature is located
    outside of the medical record, it should not be
    reviewed and used in abstraction.
  • Documentation must clearly convey that (1)
    instructions regarding discharge instruction
    category, e.g., "activity" are included in the
    material, and (2) the patient was given a copy to
    take home.

7
Pneumonia
  • New data elements
  • Another Suspected Source of Infection
  • Collected for antibiotic selection PN-6a and
    PN-6b
  • If there was another suspected source of
    infection in addition to pneumonia upon admission
    then the patient is excluded from the measure
    set.
  • Pneumonia Diagnosis ED/Direct Admit
  • Replaces Working Diagnosis on Admission
  • Collected for PN-1, PN-3a, PN-3b, PN-5 and PN-6
  • Separates emergency room from direct admit within
    the algorithm
  • Direct Admit (2) will be excluded from PN-3b

8
Retired or Revised Data Elements
  • Retired data elements
  • Antibiotics Prior to Arrival
  • Pneumonia Working Diagnosis on Admission
  • Revised data elements
  • Antibiotic Received
  • Revised notes for abstraction
  • Comfort Measures Only
  • Healthcare Associated PN
  • Pneumococcal Vaccine Status
  • Pseudomonas Risk
  • Clinical Trial
  • Pneumonia Antibiotic Consensus Recommendations
    changes

9
Algorithm changes
  • PN-3b
  • Only records with an admit source of 7 will be
    included
  • Blood culture collected after arrival removed
  • PN-6, PN-6a and PN-6b
  • Pneumonia Antibiotic Consensus Recommendations
    changes
  • Parenteral Quinolones is now used for ICU
    patients
  • Quinolones is only applicable for Non-ICU because
    it contains an oral quinolone
  • Changes to medication tables

10
Antibiotic Abstraction Guidelines
  • Collect only antibiotics administered via an
    appropriate route
  • (SCIP-Inf PO and IV PN PO, IV and IM)
  • In narrative documentation, only accept
    documentation that reflects the actual
    administration of the antibiotic. The use of
    "hang time" or "infusion time" is acceptable ONLY
    on the ED record when other documentation cannot
    be found.
  • Core Options edit for antibiotics that are more
    than 15 minutes prior

11
Antibiotic Table Changes
  • PN
  • New Table 2.14 Quinolones Parenteral
  • PN and SCIP
  • Table 2.1 Antimicrobial Medications Table
  • Table 2.2 Immunosuppressive Medications
  • Table 4.0 Antibiotic Allergy Table
  • SCIP
  • Table 3.1 Cardiac or Vascular
  • Table 3.5 Colon - Parenteral
  • Table 3.7 Hysterectomy

12
SCIP General Changes
  • Core Options will only look at the principal
    procedure for inclusion into the SCIP measure set
  • Patients whose ICD-9-CM principal procedure
    occurred prior to the date of admission are now
    excluded
  • Admitting diagnosis code is no longer an
    exclusion for infection. Only principal
    diagnosis codes will be accepted
  • Surgery Start Date is now collected for all SCIP
    measures.

13
SCIP
  • New Indicators
  • Cardiac  
  • SCIP-Card-2
  • Surgery Patients on Beta Blocker Therapy Prior to
    Admission Who Received a Beta Blocker During the
    Perioperative Period
  • VTE  
  • SCIP-VTE-1
  • Surgery Patients with Recommended Venous
    Thromboembolism Prophylaxis Ordered
  • SCIP-VTE-2
  • Surgery Patients Who Received Appropriate Venous
    Thromboembolism Prophylaxis Within 24 Hours Prior
    to Surgery to 24 Hours After Surgery

14
Retired Data Elements
  • Retired data elements
  • Admission Diagnosis of Infection
  • Antibiotics During Stay
  • Antibiotics Prior to Arrival
  • Early Antibiotics
  • Infection Procedure of Interest
  • Surgery Performed During Stay

15
New data elements
  • SCIP Cardiac data elements
  • Beta Blocker Current Medication
  • Beta Blocker Perioperative
  • Contraindication to Beta Blocker - Perioperative
  • Perioperative Death
  • SCIP VTE data elements
  • Contraindication to VTE Prophylaxis
  • Discharge Time
  • Documented Bleeding Risk
  • Neuraxial Anesthesia
  • Preadmission Warfarin
  • VTE Laparoscope
  • VTE Prophylaxis
  • VTE Timely

16
Revised data elements
  • Surgical incision time
  • Intraop Death
  • Surgery End Date and Time
  • Surgery Start Date and Incision Time
  • Temperature Value
  • Vancomycin
  • Glucose POD 1 Glucose POD 2
  • Postoperative Infections
  • Infection Prior to Anesthesia
  • Other Surgeries

17
ICD-9 Code Changes
  • Table 5.06 Abdominal Hysterectomy
  • Remove procedure codes
  • 68.4, 68.6
  • Add procedure codes
  • 68.49, 68.69
  • Table 5.07 Vaginal Hysterectomy
  • Remove procedure code
  • 68.7
  • Add procedure code
  • 68.79

18
SCIP algorithm changes
  • SCIP-inf-2
  • Prophylactic Antibiotic Regimen Selection for
    Surgery
  • Remove Cefamandole and Cefmetazole from the
    tables
  • SCIP-inf-3
  • Two new processes have been added to the
    flowchart for SCIP-Inf-3. These processes remove
    from consideration any antibiotic doses
    administered more than two days after surgery
    ended (three days for CABG and Other Cardiac
    surgeries)
  • SCIP-inf-7
  • Change the Numerator Statement to read Surgery
    patients whose first recorded temperature was
    greater than or equal to 96.8 º F within the
    first hour after leaving the operating room

19
SCIP Flowchart
Initial SCIP Population Principal ICD-9 Procedure
Code Table 5.10
20
SIP to SCIP Transition
  • Why the sudden increase in cases?
  • Creation of a new surgery type called Major
    Surgery
  • Eligible for only SCIP-inf-4,6,7 as appropriate
    and for CARD-2 and VTE-1 and 2 with October
    discharges
  • Why are non-surgical cases such as 3rd and 4th
    degree laceration included?
  • The ICD-9 population is defined by JCAHO and CMS
    as all records with either a principal or
    secondary procedure found in Table 5.10
  • Table is currently being reviewed and an update
    is expected in April 2007

21
SIP to SCIP Transition
  • Do I have to do the new indicators?
  • Officially the answer is no
  • SCIP-Inf-4, 6 and 7 are not endorsed by the
    National Quality Forum
  • Hospitals can elect to skip questions relevant to
    SCIP-Inf-4, 6 and 7, and Core Options will
    submit only SCIP-Inf-1, 2 and 3 to both JCAHO and
    CMS
  • What if I choose not to?
  • Contact either Laurie Morris or myself
  • For October discharges forward you can change
    your facility settings
  • Contact JCAHO if you have elected SCIP as a
    measure set to let them know so they can adjust
    their selection report

22
SIP to SCIP Transition
  • I normally do 100 of SIP and now have too many
    cases. Can I sample just Major Surgery
  • Yes, sampling is done per surgery type.
  • You can continue to do 100 of your normal
    surgeries and sample the new Major Surgery type
  • How do I create a sample?
  • You cannot create your own sample
  • You need to turn on sampling with the Facility
    Settings section and then create the sample for
    each surgery type within the abstract module

23
Creating a SCIP Sample Set-up
  • Set-up SCIP to allow for sampling
  • Go to TOOLSgtAdministrative and select Facility
    SettingsgtSelected Measures Tab
  • If it is grayed out then you do not have
    sufficient rights within Core Options
  • Contact the administrator within your facility
  • Select each instance of SCIP and select Edit
    Measure
  • All you need to do is check the Allow Sampling
    for this measure and click the Save Button
  • Exit this area by selecting the Facility
    Settings in the upper left hand corner

24
Creating the Sample Abstract Module
  • Select a surgery type from the Applied Filter
    drop down
  • Samples are created per surgery type
  • You can elect to continue to do 100 of SIP and
    sample only those with a surgery type of Major
    Surgery
  • Click Create Sample
  • Confirm that all records all available
  • All imports have to be done
  • Records in yellow and marked Sample are to be
    done
  • Surgeries that are not sampled
  • Do all records
  • We send to JCAHO and CMS those marked for
    sampling and all records from surgeries not
    sampled at all
  • Want to see an example Click HERE

25
Core Options Software Changes
  • Provide an APU SCIP
  • Go to the facility settings area and remove all
    SIP measures
  • Add back in as APU SCIP
  • Custom Questions need to be added back to the APU
    measure
  • Allow for record view of letter assignments with
    the abstract module
  • Select record and it will display the letter
    assignments for each indicator
  • For SCIP it will let you know if the patient had
    a principal diagnosis code of infection or was a
    burn or transplant patient
  • Critical Access Changes
  • Transfer pneumonia patients will now include only
    ER patients with a discharge status indicating
    transfer similar to the ER Measure
  • Sampling allowed for the ER measure following the
    pregnancy sampling requirements

26
QUESTIONS
  • Teresa Osieczonek
  • E-mail tosieczonek_at_mha.org
  • Phone (517) 886-8399

Laurie Morris E-mail lmorris_at_mha.org Phone
(517) 886-8209
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