• 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 acute myocardial infarction (AMI) patients without beta-blocker contraindications who are prescribed a beta-blocker at hospital discharge.

The use of beta-blockers for patients who have suffered an acute myocardial infarction (AMI) can reduce mortality and morbidity. Studies have demonstrated that the use of beta-blockers is associated with about a 20% reduction in this risk, and there is evidence of effectiveness in broad populations of patients with AMI. National guidelines strongly recommend long-term beta-blocker therapy for the secondary prevention of subsequent cardiovascular events in patients discharged after AMI. Despite these recommendations, beta-blockers remain underutilized in eligible older patients discharged after AMI.

Acute myocardial infarction (AMI); beta-blocker

Acute myocardial infarction (AMI) patients without beta-blocker contraindications (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Acute myocardial infarction (AMI) patients who are prescribed a beta-blocker at hospital discharge

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

Overall poor quality for the performance measured

Current routine use

Accreditation
Collaborative inter-organizational quality improvement
External oversight/Medicaid
External oversight/Medicare
Internal quality improvement
National reporting
Pay-for-performance

Hospitals

Measure is not provider specific

Single Health Care Delivery Organizations

Age greater than or equal to 18 years

Either male or female

Unspecified

Each year 900,000 people in the United States (U.S.) are diagnosed with acute myocardial infarction (AMI); of these, approximately 225,000 cases result in death and, it is estimated that an additional 125,000 patients die before obtaining medical care.

• American College of Cardiology, American Heart Association Task Force on Practice Guidelines, Committee on Management of Acute Myocardial Infarction. 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. Bethesda (MD): American College of Cardiology (ACC), American Heart Association (AHA); 1999. Various p.

Unspecified

Cardiovascular disease, including acute myocardial infarction (AMI), is the leading cause of death in the United States (U.S.).

Cardiovascular disease, including acute myocardial infarction (AMI), is the primary disease category for hospital patient discharges.

Unspecified

Getting Better
Living with Illness

Effectiveness

Users of care only

Discharges, 18 years of age and older, with a principal diagnosis of acute myocardial infarction (AMI)

Patients associated with provider

Inclusions
Discharges, 18 years of age and older, with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Diagnosis Code for acute myocardial infarction (AMI) as defined in Appendix A, Table 1.1, of the original measure documentation

Exclusions

• Patients less than 18 years of age
• Patients transferred to another acute care hospital or federal hospital
• Patients who expired
• Patients who left against medical advice
• Patients discharged to hospice
• Patients with comfort measures only documented by a physician/advanced practice nurse/physician assistant (physician/APN/PA)
• Patients involved in clinical trials
• Patients with one or more of the following beta-blocker contraindications/reasons for not prescribing a beta-blocker documented in the medical record:
  • Beta-blocker allergy
  • Bradycardia (heart rate less than 60 beats per minute [bpm]) on day of discharge or day prior to discharge while not on a beta-blocker
  • Second- or third-degree heart block on electrocardiogram (ECG) on arrival or during hospital stay and does not have a pacemaker
  • Other reasons documented by a physician/APN/PA for not prescribing a beta-blocker at discharge

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

Clinical Condition
Institutionalization

Time window is a single point in time

Inclusions
Acute myocardial infarction (AMI) patients who are prescribed a beta-blocker at hospital discharge

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.

Encounter or point in time

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

The core measure pilot project was a collaboration among The Joint Commission, five state hospitals associations, five measurement systems, and 83 hospitals from across nine states. Participating hospitals collected and reported data for acute myocardial infarction (AMI) measures from December 2000 to December 2001.

Core measure reliability visits were completed the summer of 2001 at a random sample of 16 participating hospitals across 6 states.

Preliminary pilot test data reveals a mean rate of 90% for this measure.

• The Joint Commission. A comprehensive review of development and testing for national implementation of hospital core measures. Oakbrook Terrace (IL): The Joint Commission; 40 p.

AMI-5: beta-blocker prescribed at discharge.

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.

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

Hospital Compare
Hospital Quality Alliance
National Healthcare Disparities Report (NHDR)
National Healthcare Quality Report (NHQR)

Measure was not adapted from another source.

2000 Aug

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 February 7, 2003. The information was verified by the measure developer on February 12, 2003. This NQMC summary was updated by ECRI on October 6, 2005 and on April 16, 2007. The information was verified by the measure developer on July 24, 2007. This NQMC summary was updated again 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.