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CMS Core Measures Evidencebased Performance Measurement


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Title: CMS Core Measures Evidencebased Performance Measurement

CMS Core MeasuresEvidence-based Performance
Learning Objectives
  • Describe evidence-based medicine.
  • Identify CMS core measures and the purpose for
    measuring performance.
  • Describe the core measures for each clinical

What is evidence-based medicine?
  • Patient care that research has shown to result in
    better outcomes for patients, such as lower
  • Mortality and morbidity
  • Disability
  • Length of stay
  • Readmissions

What is a core measure?
  • The percentage of eligible patients that receive
    care represented by the measure.
  • Example Percentage of AMI patients that
    receive aspirin on arrival.

Why are we here today?
  • 1 Reason The PATIENT
  • It isnt just about the numbers.
  • it is about the right care every time.

Other reasons to improve your core measure rates
  • Assure your community and your Board of
    Directors that you are providing high quality
  • Receive higher reimbursement from Medicare and
    other payers.

National Clinical Focus Areas
  • Heart Failure (HF)
  • Acute Myocardial Infarction (AMI)
  • Pneumonia (PN)
  • Surgical Care Improvement Project (SCIP)

Heart Failure
  • Heart failure accounts for more than 700,000
    hospitalizations every year.
  • Heart Failure is associated with high rates of
    mortality and morbidity.

Heart Failure, contd
  • It is a common disease in the elderly, accounting
    for more hospital admissions than any other
    diagnosis in patients over the age of 65. 
  • The prevalence of heart failure is rising
    dramatically with the aging of the US population.

Acute Myocardial Infarction
  • Cardiovascular disease is America 's biggest
  • Each year approximately 1.1 million people have a
    heart attack. 
  • Almost two-thirds of heart attack patients do not
    make a complete recovery.
  • People who survive the acute phase have a chance
    of related illness and death that is 2 to 9 times
    higher than that of the general population.

  • Pneumonia and influenza are the fifth leading
    causes of death in the United States in patients
    age 65 years and older. 
  • Pneumonia accounts for nearly 600,000 Medicare
    patient hospitalizations utilizing more than 4.5
    million inpatient days each year. 

Pneumonia, continued
  • Pneumonia also is the principal reason for more
    than 500,000 emergency department visits by
    Medicare patients each year. 
  • The incidence of pneumonia increases with age,
    and more than 90 percent of deaths due to this
    condition are in the population aged 65 and

Impact of Surgical Care Complications
  • 22 of preventable deaths attributed to
    postoperative complications
  • Approximately 500,000 surgical site
    infections(SSI) occur annually in the United
  • Patients that develop SSI have twice the
    mortality and are
  • 60 more likely to spend time in ICU
  • 5 times more likely to be readmitted

Surgical Care Complications, contd
  • Surgical patients are 20 times more likely to
    have venous thromboembolism (VTE)
  • Deep vein thrombosis (DVT) and/or
  • Pulmonary embolism (PE)
  • PE causes 300,000 deaths per year and is the
    third leading cause of hospital death

Heart Failure Measures
  • Complete discharge instructions
    (six components)
  • Left ventricular function assessment
  • ACE Inhibitor or ARB prescribed at discharge for
    left ventricular systolic dysfunction
  • Adult smoking cessation counseling

Acute MI Measures
  • Aspirin at arrival
  • Aspirin prescribed at discharge
  • ACE Inhibitor/ARB prescribed at discharge for
    left ventricular systolic dysfunction
  • Adult smoking cessation counseling

Acute MI Measures contd
  • Beta Blocker prescribed at discharge
  • Beta Blocker at arrival
  • Thrombolysis within 30 minutes
  • Percutaneous coronary intervention within 90

Pneumonia Measures
  • Oxygenation assessment
  • Blood cultures performed within 24 hours Prior to
    or after Hospital Arrival (ICU patients)
  • Blood cultures performed before 1st antibiotic
    received in hospital

Pneumonia Measures
  • Adult smoking cessation counseling
  • Antibiotic timing (w/in 6 hrs of arrival)
  • Initial antibiotic selection for community
    acquired pneumonia (CAP) in immunocompetent
  • Influenza vaccination
  • Pneumococcal vaccination

Surgical Care Improvement Project Measures
  • Infection prevention
  • Antibiotic given within one hour prior to surgery
  • Recommended antibiotic given
  • Antibiotic dcd within 24 hours after surgery
  • Appropriate hair removal
  • Normothermia (colon patients)
  • Glucose control (cardiac patients)

Surgical Care Improvement Project Measures
  • Venous thromboembolism prophylaxis
  • Ordered
  • Received
  • Cardiovascular
  • Patients on Beta Blockers prior to admission
    receive Beta Blockers in hospital

  • Evidence Supporting
  • the Core Measures

Evidence Aspirin
  • Use of aspirin for AMI patients results in a
    reduction of adverse events and mortality
    equivalent to thrombolytic therapy.
  • Aspirin provides an additive effect when used in
    combination with thrombolytics.

Evidence ACE Inhibitors ARBs
  • ACEIs ARBs are medications that reduce
    angiotensin absorption by blood vessels,
    resulting in lower vascular resistance.
  • ACEIs ARBs reduce morbidity and mortality in
    patients with left ventricular systolic

Evidence Beta Blockers
  • Beta Blockers cause vasodilation and reduce
    peripheral vascular resistance.
  • Beta Blockers significantly reduce morbidity and
    mortality in AMI patients.

Evidence Timing of thrombolytics and
percutaneous coronary interventions
  • Early reperfusion of coronary arteries saves
    heart muscle and reduces disability and
  • Nearly 2 lives per 1,000 patients are lost per
    hour of delay.

Evidence Heart Failure Discharge Instructions
  • Patients and their families that learn to manage
    heart failure can reduce morbidity and mortality.
  • Knowing to contact their physician for
    appointments and medication adjustments can
    prevent readmissions.

Evidence Blood Cultures
  • Pneumonia patients sick enough to be admitted to
    the ICU should have blood cultures drawn.
  • Results can be used to optimize antibiotic

Evidence Timing of Initial Antibiotic
  • For patients with community acquired pneumonia,
    studies have shown that giving antibiotics within
    6 8 hours of arrival reduces mortality by 15

Evidence Selection of Initial Antibiotic
  • Pneumonia patients should be assessed for
    severity of illness, allergies, and pseudomonal
  • Different combinations of initial (empiric)
    antibiotics are recommended based on patient
  • Patients receiving recommended antibiotics have a
    lower mortality rate.

Evidence Influenza and Pneumococcal Immunizations
  • Over 30,000 people in the U.S. die each year from
    influenza and pneumonia.
  • Clinics and physician offices are ineffective in
    immunizing large numbers of eligible patients.
  • The most vulnerable patients are hospital

Influenza and Pneumococcal Immunizations, contd
  • Texas law requires hospitals to assess patients
    and offer these immunizations to patients age 65
    and older.
  • The influenza vaccine is made from dead viruses.
    While patients may experience short-term flu-like
    symptoms, they cannot catch the flu from the

Influenza and Pneumococcal Immunizations, contd
  • The influenza vaccine is highly effective in
    preventing influenza-related pneumonia,
    hospitalization, and death.
  • The pneumococcal vaccine is up to 75 effective
    in preventing pneumococcal bacteremia and

Evidence Prophylactic Antibiotics for Surgery
  • Antibiotics are most effective when given within
    one hour prior to surgery.
  • Short duration antibiotics are as effective in
    preventing infection as long duration
  • Long duration antibiotics are more likely to
    cause development of drug resistant bacteria.

Evidence Appropriate Hair Removal
  • Shaving with a razor creates small nicks at the
    surgical site that can become infected.
  • Hair removal with clippers or depilatories
    results in significantly lower infection rates.

Evidence Normothermia
  • Hypothermia causes vasoconstriction, reducing
    delivery of IV medications.
  • Hypothermia suppresses the immune system.
  • In one study, colorectal surgery patients that
    maintained normothermia had an infection rate
    two-thirds lower than control patients.

Evidence Blood Glucose Control
  • CABG patients with uncontrolled blood glucose
    have significantly higher infection rates.
  • Deep wound infections in diabetic cardiac surgery
    patients were reduced by controlling mean blood
    glucose levels below 200mg/dL.

Evidence Venous Thromboembolism Prophylaxis (VTE)
  • Surgical patients are at high risk of developing
    VTE (deep vein thrombosis or pulmonary embolism).
  • Pulmonary embolism is the most common preventable
    cause of hospital death in the U.S.
  • Use of anticoagulants and intermittent
    compression devices provides effective

What is your hospital doing to improve care?
  • (List processes implemented or being tested that
    should improve core measure performance.)

What can nurses do to help?
  • (Examples - modify for your hospital)
  • Be a part of the processvolunteer to test a
    change or try a new form.
  • Documentation Use forms/screens developed.
  • Provide smoking cessation counseling administer
    flu and pneumococcal vaccinations.
  • Realize you can impact patient outcomes.

Information Source
  • You can find a brief literature review for each
    measure at
  • Hospitals Inpatient
  • Measurement Information
  • Measurement Information Form

This material was prepared by TMF Health Quality
Institute, the Medicare Quality Improvement
Organization for Texas, under contract with the
Centers for Medicare Medicaid Services (CMS),
an agency of the U.S. Department of Health and
Human Services. The contents presented do not
necessarily reflect CMS policy. 8SOW-TX-HOQI-08-03
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