Glossary of Definitions for Core Measures

Acute Myocardial infarction Indicator (AMI) Core Measures

Number of Acute Myocardial Infarction (AMI) Patients - The number of patients admitted with a heart attack during a given time period. It is important to remember that different periods will have different volumes even if the hopsital performed has not changed. This is especailly evident during warmer months. GHS

Average number of minutes before outpatients with chest pain or possible heart attack who needed specialized care were transferred to another hospital - If a hospital does not have the facilities to provide specialized heart attack care, it transfers patients with possible heart attack to another hospital that can given them this care. This measure shows how long it takes, on average, for hospitals to identify patients who need specialized heart attack care the hospital cannot provide and begin their transfer to another hospital. It shows the average (median) number of minutes it takes from the time patients arrive in the Emergency Department until they are transported to a different hospital. CMS

Average number of minutes before outpatients with chest pain or possible heart attack got an ECG - "ECG" (sometimes called EKG) stands for electrocardiogram. An ECG is a test that can help doctors know whether patients are having a heart attack. Process of care say that patients with chest pain or a possible heart attack should have an ECG upon arrival, preferably within 10 minutes. This measure tells the average (median) number of minutes it takes before patients got an ECG. Sometimes patients get an ECG done before they get to the hospital (for example, by the ambulance staff). This is counted as "0 minutes." CMS

Percent of AMI outpatients who received drugs to break up blood clots within 30 minutes of arrival - Blood clots can cause heart attacks. Certain patients having a heart attack should get a "clot busting" drug to help break up the blood clots and improve blood flow to the heart. Standards for care say that a clot busting drug should be given within 30 minutes of arrival at the hospital. This measure tells the percent of patients who got a clot busting drug within 30 minutes of arrival.CMS

Percent of AMI outpatients with pain or possible heart attack who received aspirin within 24 hours of arrival or prior to transfer - Blood clots can cause heart attacks. For many patients having a heart attack, taking aspirin soon after symptoms of a heart attack begin may help break up a clot and make the heart attack less severe. If patients have not taken aspirin themselves before going to the hospital, they should get aspirin when they arrive. Standards for care say patients should get aspirin within 24 hours of arrival at the hospital.This measure tells what percent of patients got aspirin within this time period. CMS

Percent of AMI patients given fibrinolytic medication within 30 minutes of arrival - Blood clots can cause heart attacks. Patients having a heart attack be given fibrinolytic medication to prevent blood clots from growing and improve blood flow. Standards say that afibrinolytic medication should be given within 30 minutes of arrival at the hospital. This measure tells the percent of patients who recieved fibrinolytic medication within 30 minutes of arrival.CMS

Percent of AMI patients given PCI within 90 minutes of arrival - Heart attack patient with a clogged artery in the heart that is opened with a balloon therapy called PCI within 90 minutes of hospital arrival. This measure reports how quickly heart attack patients had a clogged artery in the heart opened with a balloon therapy called PCI to increase blood flow to the heart and reduce heart damage. Lack of blood supply to heart muscle can cause lasting heart damage. In certain types of heart attacks, a small balloon is threaded into a blood vessel in the heart to open up a clogged artery that keeps the blood from flowing to the heart muscle.It is important that this therapy be given quickly after a heart attack is diagnosed. CMS

Percent of AMI patients given aspirin at discharge - Heart attack patients who receive a prescription for aspirin when being discharged from the hospital. This measure reports how often aspirin was prescribed to heart attack patients when they are leaving a hospital. Aspirin is beneficial because it reduces the tendency of blood to clot in blood vessels of the heart and improves survival rates. CMS

Heart attack patients given a prescription for a statin at discharge - Heart attack patients who have a medicine called a “statin” prescribed when they are discharged from the hospital. This measure reports what percent of heart attack patients were prescribed a special type of medicine when leaving the hospital that has been shown to reduce further heart damage. CMS

Optimal Care ("All-or-None Bundle") - The optimal care measure is a condition-level summary score that uses the "all or none" methodology to determine if a patient received all of the recommended treatment for which they were eligible. For each condition on this site (AMI, heart failure, pneumonia, surgical care), performance is determined at the patient level and then summarized per hospital. A hospital optimal care percentage score is calculated with this formula (per condition): Total # patients receiving all care measures / Total # patients qualifying for any care. North Carolina Medical Journal

Community Acquired Pneumonia (CAP) Core Measures

Number of Community Acquired Pneumonia (AMI) Patients - The number of patients who were not recently hosptialized develop pneumonia during a given time period. It is important to remember that different periods will have different volumes even if the hopsital performed has not changed. This is especailly evident during cooler months.GHS

Pneumonia patients whose initial emergency room blood culture was performed prior to the first administration of the first hospital dose of antibiotics. - Pneumonia patients who were admitted through the Emergency Department who had a blood test in the Emergency Department for the presence of bacteria in their blood. Before antibiotics are given, blood samples are taken to test for the type of infection. This measure reports the percent of pneumonia patients admitted through the Emergency Department who receive this test before antibiotics were given. CMS

Pneumonia patients given the most appropriate initial antibiotic(s). - Patients that have community-acquired pneumonia who received the appropriate medicine (antibiotic) that has been shown to be effective for community-acquired pneumonia. This measure reports how often patients in intensive care units with community acquired pneumonia were given the correct antibiotic within 24 hours of hospital arrival, based on recommendations from written guidelines for the treatment of pneumonia.CMS

Patient Satisfaction (HCAHPS) Measures

Number of patient satisfaction surveys completed - Surveys are sent to individuals asking questions about their hospital stay. The number of patient satisfaction surveys completed is the number of surveys that are received completed. It is important to remember that different periods will have different volumes even if the hospital performed has not changed. This is especially evident during warmer months.CMS

Patients who reported that their nurses ALWAYS communicated well - Patients reported how often their nurses communicated well with them during their hospital stay. "Communicated well" means nurses explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect.CMS

Patients who reported that their doctors ALWAYS communicated well. - Patients reported how often their doctors communicated well with them during their hospital stay. "Communicated well" means doctors explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect.CMS

Patients who reported that they ALWAYS received help as soon as they wanted. - Patients reported how often they were helped quickly when they used the call button or needed help in getting to the bathroom or using a bedpan.CMS

Patients who reported that their pain was ALWAYS well controlled. - If patients needed medicine for pain during their hospital stay, the survey asked how often their pain was well controlled. "Well controlled" means their pain was well controlled and that the hospital staff did everything they could to help patients with their pain.CMS

Patients who reported that staff ALWAYS explained about medecines before giving it to them. - If patients were given medicine that they had not taken before, the survey asked how often staff explained about the medicine. "Explained" means that hospital staff told what the medicine was for and what side effects it might have before they gave it to the patient.CMS

Patients who reported that their room and bathroom were ALWAYS clean. - Patients reported how often their hospital room and bathroom were kept clean.CMS

Patients who reported that the area around their room was ALWAYS quiet at night. - Patients reported how often the area around their room was quiet at night.CMS

Patients at each hospital who reported that YES they were given information about what to do during their recovery time. - The survey asked patients about information they were given when they were ready to leave the hospital. Patients reported whether hospital staff had discussed the help they would need at home. Patients also reported whether they were given written information about symptoms or health problems to watch for during their recovery.CMS

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest). - After answering all other questions on the survey, patients answered a separate question that asked for an overall rating of the hospital. Ratings were on a scale from 0 to 10, where "0" means "worst hospital possible" and "10" means "best hospital possible."

Willingness to Recommend this HospitalCMS

Would patients recommend the hospital to friends and family? - The survey asked patients whether they would recommend the hospital to their friends and family.CMS

Heart Failure (HF) Core Measures

Number of Heart Failure Patients - The number of patients who were admitted for heart failure during a given time period. It is important to remember that different periods will have different volumes even if the hopsital performed has not changed. This is especailly evident during cooler months. CMS

Percent of heart failure patients given discharge instructions. - Heart failure patients who receive all specific discharge instructions about their condition. This measure reports what percent of patients with heart failure are given all information about their condition and care when they leave the hospital. Patient education about medicines, diet, activities, and signs to watch for is important in order to prevent further hospitalization.CMS

Percent of heart failure patients given an evaluation of Left Ventricular Systolic (LVS) function. - Heart failure patients who have had the function of the main pumping chamber of the heart (i.e. ventricle) checked during their hospitalization. This measure reports what percent of patients with heart failure receive an in-depth evaluation of heart muscle function in order to receive the right treatments for their heart failure.CMS

Percent of heart failure patients given an ACE inhibitor or ARB for Left Ventricular Systolic Dysfunction (LVSD). - Heart failure patients who receive a prescription for a medicine called an "ACE inhibitor" or a medicine called an angiotensin receptor blocker (ARB) when they are discharged from the hospital. Most patients who have heart failure and who take ACE inhibitor medicine have fewer symptoms, are physically better, and reduce their risk of returning to the hospital. The number of patients prescribed this drug is measured.CMS

Surgical Care Improvement Patients (SCIP) Core Measures

Number of Surgical Care Patients - The number of surgical patients during a given time period. It is important to remember that different periods will have different volumes even if the hopsital performed has not changed. This is especailly evident during cooler months.CMS

Percent of SCIP Outpatients Receiving Preventative Antibiotic(s) One Hour before Incision - Hospitals can prevent surgical wound infections. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections. The timing is important: getting an antibiotic earlier, or after surgery begins, is not as effective. Hospital staff should make sure patients get antibiotics at the right time. Higher numbers are better.CMS

Percent of outpatients having surgery who got the right kind of antibiotic. - Certain antibiotics are recommended to help prevent wound infection for particular types of surgery. This measure looks at how often surgical patients get the appropriate antibiotic in order to prevent a surgical wound infection.CMS

Percent of surgery patients who were taking heart drugs called beta blockers before coming to the hospital, who were kept on the beta blockers during the period just before and right after their surgery. - CMS

Percent outpatients having surgery who got on an antibiotic at the right time (within one hour before surgery). - Research shows that surgery patients who get antibiotics within the hour before their operation are less likely to get wound infections. Getting an antibiotic earlier, or after surgery begins, is not as effective. This measure shows how often a surgery patient gets antibiotics at the right time.CMS

Percent of surgery patients who were given an antibiotic at the right time (within one hour before surgery) to help prevent infection. - Hospitals can prevent surgical wound infections. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery. Hospital staff should make sure patients get the antibiotic that works best for their type of surgery. Higher numbers are better.CMS

Percent of surgery patients whose preventive antibiotics were stopped at the right time (within 24 hours after surgery). - While the likelihood of infection after surgery can be reduced by giving patients preventative antibiotics, taking these antibiotics for more than 24 hours after routine surgery is usually not necessary and can increase the risk of side effects such as diarrhea, and antibiotic resistance (when antibiotics are used too much, they will not work anymore.)CMS

Percent of heat surgery patients whose blood sugar (blood glucose) is kept under good control in the days right after surgery.CMS

Percent of surgery patients who were given the right kind of antibiotic to help prevent infection.CMS

Percent of surgery patients whose urinary catheters were removed on the first or second day after surgery.CMS

Patients having surgery who were actively warmed in the operating room or whose body temperature was near normal by the end of surgery.CMS

Surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgeries. - A number of factors can increase a patient's risk of developing blood clots, but doctors can order preventive treatments called prophylaxis to reduce the risk. Prophylaxis may include blood thinning medications, elastic support stockings, or mechanical air stockings that promote circulation in the legs.CMS

Percent of surgery patients whose doctors ordered treatments to prevent blood clots after certain types of surgeries.CMS

Patients who got treatment at the right time (within 24 hours before or after surgery) to help prevent blood clots after certain types of surgery.CMS

Stroke (STK) Core Measures

Number of Stroke (STK) Patients - The number of stroke patients during a given time period. It is important to remember that different periods will have different volumes even if the hopsital performed has not changed. This is especailly evident during cooler months.CMS

Percent of Stroke Patients Receiving VTE prophylaxis - Ischemic and hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission. Stroke patients are at increased risk of developing venous thromboembolism (VTE). One study noted proximal deep vein thrombosis in more than a third of patients with moderately severe stroke. Reported rates of occurrence vary depending on the type of screening used. Prevention of VTE, through the use of prophylactic therapies, in at risk patients is a noted recommendation in numerous clinical practice guidelines. For acutely ill stroke patients who are confined to bed, thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heaparin (LDUH), or fondaparinux is recommended if there are no contraindications. Aspirin alone is not recommended as an agent to prevent VTE.CMS

Percent of Stroke Patients Discharged on Antithrombotic Therapy - Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge. The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. Warfarin is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke.CMS

Percent of Stroke Patients Prescribed Anticoagulation Therapy for Atrial Fibrillation/Flutte - Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge. Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack(TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.CMS

Percent of Stroke Patients Receiving Thrombolytic Therapy - Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well. The administration of thrombolytic agents to carefully screened, eligible patients with acute ischemic stroke has been shown to be beneficial in several clinical trials. These included two positive randomized controlled trials in the United States; The National Institute of Neurological Disorders and Stroke (NINDS) Studies, Part I and Part II. Based on the results of these studies, the Food and Drug Administration approved the use of intravenous recombinant tissue plasminogen activator (IV r-TPA or t-PA) for the treatment of acute ischemic stroke when given within 3 hours of stroke symptom onset. A large meta-analysis controlling for factors associated with stroke outcome confirmed the benefit of IV t-PA in patients treated within 3 hours of symptom onset. While controversy still exists among some specialists, the major society practice guidelines developed in the United States all recommend the use of IV t-PA for eligible patients. Physicians with experience and skill in stroke management and the interpretation of CT scans should supervise treatment.CMS

Percent of Stroke Patients Receiving Antithrombotic Therapy By End of Hospital Day 2 - CMS

Percent of Stroke Patients Discharged on Statin Medication - Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2. The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.CMS

Percent of Stroke Patients Receiving Stroke Education - Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. There are many examples of how patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. The type of stroke experienced and the resulting outcomes will play a large role in determining not only the course of treatment but also what education will be required. Patient education should include information about the event (e.g., cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient's prognosis and potential for rehabilitation.CMS

Percent of Stroke Patients Assessed for Rehabilitation - Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services. Each year about 700,000 people experience a new or recurrent stroke, which is the nation's third leading cause of death. Approximately two thirds of these individuals survive and require rehabilitation. Stroke is a leading cause of serious, long-term disability in the United States, with about 4.4 million stroke survivors alive today. Forty percent of stroke patients are left with moderate functional impairment and 15 to 30 percent with severe disability. More than 60% of those who have experienced stroke, serious injury, or a disabling disease have never received rehabilitation. Stroke rehabilitation should begin as soon as the diagnosis of stroke is established and life-threatening problems are under control. Among the high priorities for stroke are to mobilize the patient and encourage resumption of self-care activities as soon as possible. A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. The primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function.CMS

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