• Specifications manual for national hospital quality measures, version 2.3b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2007 Oct. various p.

Does not apply to this measure

This measure is used to assess the percent of surgery patients on beta-blocker therapy prior to admission who received a beta-blocker during the perioperative period*.

*The perioperative period for the Surgical Care Improvement Project (SCIP) cardiac measures is defined as 24 hours prior to surgical incision through discharge from post-anesthesia care/recovery area.

In patients at risk of cardiovascular complications in a variety of medical conditions, beta-blockers have been shown to reduce that risk. Studies show that patients with a history of myocardial infarction who have had beta-blocker therapy initiated and continued, have a 20 to 30 percent reduction in subsequent coronary events, cardiovascular mortality, and all-cause mortality (Yusuf, Prog Cardiovasc Dis, 1985). In a meta-analysis by McGory et al. (Surgery, 2005), long-term cardiac mortality and myocardial ischemia were reduced significantly by perioperative beta blockade. Patients maintained on beta-blockers, without complications that might warrant discontinuation, are good candidates for continuation of beta-blockers through the perioperative period.

Cardiovascular complications; prevention; beta blocker therapy

All surgery patients on beta-blocker therapy prior to admission (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Surgery patients on beta-blocker therapy prior to admission who receive a beta-blocker during the perioperative period*

*The perioperative period for the Surgical Care Improvement Project (SCIP) cardiac measures is defined as 24 hours prior to surgical incision through discharge from post-anesthesia care/recovery area.

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence
• A systematic review of the clinical literature
• One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Use of this measure to improve performance

Current routine use

Accreditation
Collaborative inter-organizational quality improvement
External oversight/Medicaid
External oversight/Medicare
Internal quality improvement

Hospitals

Measure is not provider specific

Single Health Care Delivery Organizations

Age greater than or equal to 18 years

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Staying Healthy

Effectiveness
Timeliness

Users of care only

All surgery patients, age 18 years and older, on beta-blocker therapy prior to admission (see the "Denominator Inclusions/Exclusions" field)

Patients associated with provider

Inclusions
Discharges with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Procedure Code of selected surgeries as defined in Appendix A, Table 5.10, of the original measure documentation and who were on beta-blocker therapy prior to admission

Exclusions

• Patients who are less than 18 years of age
• Patients who did not receive beta-blockers due to contraindications as documented in the medical record
• Patients whose ICD-9-CM principal procedure occurred prior to the date of admission
• Patients whose ICD-9-CM principal procedure was performed entirely by laparoscope
• Patients who expired during the perioperative period
• Pregnant patients taking a beta-blocker prior to admission
• Patients involved in clinical trials

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Institutionalization
Therapeutic Intervention

Time window precedes index event

Inclusions
Surgery patients on beta-blocker therapy prior to admission who receive a beta-blocker during the perioperative period*

*The perioperative period for the Surgical Care Improvement Project (SCIP) cardiac measures is defined as 24 hours prior to surgical incision through discharge from post-anesthesia care/recovery area.

Exclusions
None

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Episode of care

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

External comparison at a point in time
External comparison of time trends
Internal time comparison

Unspecified

SCIP-Card-2: surgery patients on beta-blocker therapy prior to admission who received a beta-blocker during the perioperative period.

Centers for Medicare & Medicaid Services
Joint Commission, The

Centers for Medicare & Medicaid Services/The Joint Commission

All external funding for measure development has been received and used in full compliance with The Joint Commission's Corporate Sponsorship policies, which are available upon written request to The Joint Commission.

The Joint Commission worked with the Centers for Medicare & Medicaid Services, who assembled and maintained the Technical Expert Panel, for development of the Surgical Improvement Project (SIP) measures, The SIP set subsequently transitioned to the Surgical Care Improvement Project (SCIP) effective July 1, 2006.

SCIP Partners include the Steering Committee of 10 national organizations who have pledged their commitment and full support for SCIP:

• Agency for Healthcare Research and Quality
• American College of Surgeons
• American Hospital Association
• American Society of Anesthesiologists
• Association of Perioperative Registered Nurses
• Centers for Disease Control and Prevention
• Centers for Medicare & Medicaid Services
• Institute for Healthcare Improvement
• The Joint Commission
• Veterans Health Administration

Expert panel members have made full disclosure of relevant financial and conflict of interest information in accordance with the Joint Commission's Conflict of Interest policies, copies of which are available upon written request to The Joint Commission.

National Quality Forum

Measure was not adapted from another source.

2006 Jun

2007 Oct

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

• Specifications manual for national hospital quality measures, version 2.3b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2007 Oct. various p.

This NQMC summary was completed by ECRI on May 8, 2007. The information was verified by the measure developer on July 24, 2007. This NQMC summary was updated by ECRI Institute on October 26, 2007.

The Specifications Manual for National Hospital Quality Measures [Version 2.3b, October, 2007] is the collaborative work of the Centers for Medicare & Medicaid Services and The Joint Commission. The Specifications Manual is periodically updated by the Centers for Medicare & Medicaid Services and The Joint Commission. Users of the Specifications Manual for National Hospital Quality Measures should periodically verify that the most up-to-date version is being utilized.