Release Notes: Measure Information Form Version 2.

0 **NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Core Measure Set: Acute Myocardial Infarction Performance Measure Identifier: 14228 Performance Measure Name: (AMI-4) Adult smoking cessation advice/counseling Description: Acute myocardial infarction (AMI) patients with a history of smoking cigarettes, who are given smoking cessation advice or counseling during hospital stay. For the purposes of this measure, a smoker is defined as someone who has smoked cigarettes anytime during the year prior to hospital arrival. Rationale: Smoking cessation is essential in patients with AMI. Smoking triggers coronary spasm, reduces the anti-ischemic effects of beta blockers, and doubles mortality after AMI. Patients who receive even brief smoking-cessation advice from their physicians are more likely to quit than those who receive no counseling at all. Hospitalization can be an ideal opportunity for a patient to stop smoking, and smoking cessation may promote the patients medical recovery. Type of Measure: Process Improvement Noted As: An increase in the rate. Numerator Statement: AMI patients who receive smoking cessation advice or counseling during the hospital stay. Included Populations: Not applicable Excluded Populations: None Data Elements: Adult Smoking Counseling Denominator Statement: AMI patients with a history of smoking cigarettes anytime during the year prior to hospital arrival.

Specifications Manual for National Implementation of Hospital Core Measures

AMI-4-1

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Included Populations: Discharges with: An ICD-9-CM Principal Diagnosis Code for AMI as defined in Appendix A, Table 1.1 AND A history of smoking cigarettes anytime during the year prior to hospital arrival Excluded Populations: Patients less than 18 years of age Patients transferred to another acute care hospital Patients who expired Patients who left against medical advice Patients discharged to hospice Data Elements: Admission Date Adult Smoking History Birthdate Discharge Status ICD-9-CM Principal Diagnosis Code Risk Adjustment: No Data Collection Approach: Retrospective, data sources include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients at the time of hospital arrival. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-9-CM diagnosis codes, which require retrospective entry. Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency. Measure Analysis Suggestions: Since health care organizations may wish to assess how frequently they are documenting smoking history in the patient record, measurement systems may wish to provide such information based on the data element Adult Smoking History. Terminology: Acute myocardial infarction (AMI): Death of heart muscle resulting from insufficient blood supply to the heart. For purposes of this measure, acute myocardial infarction is identified by the ICD-9-CM codes in Appendix A, Table 1.1

Specifications Manual for National Implementation of Hospital Core Measures

AMI-4-2

Joint Commission No Unauthorized Distribution

Adult Smoking Counseling: Documentation indicating the patient received one of the following: Advice to stop smoking whether or not the patient is a current smoker; A viewing of a smoking cessation video; Brochures or handouts on smoking cessation; or A smoking cessation aid such as Nicoderm or Zyban. Sampling: Yes; for additional information see the Sampling section. Age Groups: Age 18 and older Data Reported as: Aggregate rate generated from count data reported as a proportion Selected References: Baile WF et al: Smoking following myocardial infarction: A critical review of literature. Health Psychology, 3(1): 83-96, 1984. Kikano GE, et al: The value of brief, targeted smoking-cessation advice. Family Practice Management. pp. 50:2000. Marcinak TA et al: Improving the quality of care for Medicare patients with acute myocardial infarction: Results from the Cooperative Cardiovascular Project. JAMA, 279(17):1351-1357, May 1998. Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE III, Weaver WD. ACC/AHA guidelines for the management of patients with acute myocardial infarction:1999 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Available at http://www.acc.org/clinical/guidelines and http://www.americanheart.org. Accessed on March 13, 2000. Smoking cessation. U.S. Department of Health and Human Services, Public Health Service, Clinical practice guideline; no.18. AHCPR Publication; April, 1996. pp. 124. The Smoking Cessation Clinical Practice Guideline Panel and Staff: The Agency for Health Care Policy and Research. Smoking Cessation Clinical Practice Guideline. JAMA, 275:1270-1280, 1996.

Specifications Manual for National Implementation of Hospital Core Measures

AMI-4-3

Joint Commission No Unauthorized Distribution

14228: (AMI-4) Adult smoking cessation advice/counseling

Numerator: Denominator: AMI patients who receive smoking cessation advice or counseling during the hospital stay. AMI patients with a history of smoking cigarettes anytime during the year prior to hospital arrival.

Start

Variable Key: Patient Age

AMI-4 A

Missing / Invalid

ICD-9-CM Principal Diagnosis Code

Not on Table 1.1

AMI-4 B

On Table 1.1

AMI-4 A

Missing / Invalid

Admission Date

Valid

AMI-4 A

Missing / Invalid

Birthdate

Valid

Patient Age (in years) = Admission Date minus Birthdate

Note: The algorithm to calculate age must use the month and day portion of admission date and birthdate to yield the most accurate age.

AMI-4 A

age is < 0 days (negative value)

Patient Age

age is > or = 0 days and < 18 years

AMI-4 B

(Initial population, common to all measures in the AMI set)

age is > or = 18 years

AMI-4 H

Specifications Manual for National Implementation of Hospital Core Measures

AMI-4-4

Joint Commission No Unauthorized Distribution

AMI-4 H

Missing / Invalid AMI-4 A

Discharge Status

= 02, 07, 20, 41, 43, 50 or 51 AMI-4 B

= 01, 03, 04, 05, 06, 08, 61, 62, 63, 64, 65 Missing or Invalid Measure Population Data

A
AMI-4 Z

Missing / Invalid

Adult Smoking History

= N or Z

Not In Measure Population

B
AMI-4 Z

=Y

Missing or Invalid Numerator Data

Missing / Invalid

Adult Smoking Counseling

=N

In Measure Population

=Y

In Numerator Population

E
Stop

AMI-4 Z

Specifications Manual for National Implementation of Hospital Core Measures

AMI-4-5

Joint Commission No Unauthorized Distribution