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## Complete Summary

#### TITLE

Acute myocardial infarction: percent of patients without beta-blocker
contraindications who received a beta-blocker within 24 hours after
hospital arrival.

#### SOURCE(S)

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

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percent of acute myocardial
infarction (AMI) patients without beta-blocker contraindications who
received a beta-blocker within 24 hours after hospital arrival.

#### RATIONALE

The early use of beta-blockers in patients with acute myocardial
infarction (AMI) reduces mortality and morbidity and has demonstrated
effectiveness in a wide range of AMI patients. National guidelines
strongly recommend early beta-blockers for patients hospitalized with
AMI. Despite these recommendations, beta-blockers remain underutilized
in eligible older patients hospitalized with AMI.

#### PRIMARY CLINICAL COMPONENT

Acute myocardial infarction (AMI); beta-blocker

#### DENOMINATOR DESCRIPTION

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

#### NUMERATOR DESCRIPTION

Acute myocardial infarction (AMI) patients who received a beta-blocker
within 24 hours after hospital arrival

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   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

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Overall poor quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Jencks SF, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE,
Nilasena DS, Ordin DL, Arday DR. Quality of medical care delivered to
Medicare beneficiaries: A profile at state and national levels. JAMA2000
Oct 4;284(13):1670-6.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11015797)

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

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

### Application of Measure in its Current Use

#### CARE SETTING

Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Measure is not provider specific

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

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.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

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.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

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

#### EVIDENCE FOR BURDEN OF ILLNESS

French WJ. Trends in acute myocardial infarction management: use of the
National Registry of Myocardial Infarction in quality improvement. Am J
Cardiol2000 Mar 9;85(5A):5B-9B; discussion 10B-12B.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11076125)

#### UTILIZATION

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

#### EVIDENCE FOR UTILIZATION

French WJ. Trends in acute myocardial infarction management: use of the
National Registry of Myocardial Infarction in quality improvement. Am J
Cardiol2000 Mar 9;85(5A):5B-9B; discussion 10B-12B.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11076125)

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Timeliness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

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

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**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 on day of or day after arrival

-   Patients received in transfer from an acute care facility where they
    were an inpatient or outpatient

-   Patients received as a transfer from one distinct unit of the
    hospital to another distinct unit of the same hospital

-   Patients received as a transfer from an emergency department of
    another hospital

-   Patients discharged on day of arrival

-   Patients who expired on day of or day after arrival

-   Patients who left against medical advice on day of or day after
    arrival

-   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 arrival or within 24 hours after arrival while not on a
        beta-blocker

    -   Heart failure on arrival or within 24 hours after arrival

    -   Second- or third-degree heart block on electrocardiogram (ECG)
        on arrival or within 24 hours after arrival and does not have a
        pacemaker

    -   Shock on arrival or within 24 hours after arrival

    -   Other reasons documented by a physician/APN/PA for not giving a
        beta-blocker within 24 hours after hospital arrival

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Institutionalization

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Acute myocardial infarction (AMI) patients who received a beta-blocker
within 24 hours after hospital arrival

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

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

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

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

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

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 85% for this measure.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

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.

### Identifying Information

#### ORIGINAL TITLE

AMI-6: beta-blocker at arrival.

#### MEASURE COLLECTION

[National Hospital Quality
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=11&doc=6043)

#### MEASURE SET NAME

[Acute Myocardial
Infarction](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=11&doc=6044)

#### SUBMITTER

Centers for Medicare & Medicaid Services\
Joint Commission, The

#### DEVELOPER

Centers for Medicare & Medicaid Services/The Joint Commission

#### FUNDING SOURCE(S)

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.

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

The composition of the group that developed the measure is available at:
<http://www.jointcommission.org/NR/rdonlyres/40EDE16E-0ECC-45E0-8CEC-71C97FF515D0/0/CardiovascularConditionsClinicalAdvisoryPanel.pdf>.

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

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.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

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

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2000 Aug

#### REVISION DATE

2007 Oct

#### MEASURE STATUS

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

#### SOURCE(S)

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

#### MEASURE AVAILABILITY

The individual measure, \"AMI-6: Beta-Blocker at Arrival,\" is published
in \"Specifications Manual for National Hospital Quality Measures.\" An
update of this document is available from [The Joint Commission Web
site](http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Current+NHQM+Manual.htm).
Information is also available from the [Centers for Medicare & Medicaid
Services (CMS) Web
site](http://www.cms.hhs.gov/HospitalQualityInits/10_HospitalQualityMeasures.asp#TopOfPage).
Check The Joint Commission Web site and CMS Web site regularly for the
most recent version of the specifications manual and for the applicable
dates of discharge.

#### COMPANION DOCUMENTS

The following are available:

-   A software application designed for the collection and analysis of
    quality improvement data, the CMS Abstraction and Reporting Tool
    (CART), is available from the [CMS CART Web
    site](http://qnetexchange.org/public/hdc.do?hdcPage=cart-overview).
    Supporting documentation is also available. For more information,
    e-mail CMS PROINQUIRIES at <proinquiries@cms.hhs.gov>.

-   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. This document is
    available from [The Joint Commission Web
    site](http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/).

-   The Joint Commission. Attributes of core performance measures and
    associated evaluation criteria. Oakbrook Terrace (IL): The Joint
    Commission; 5 p. This document is available from [The Joint
    Commission Web
    site](http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/).

-   Hospital compare: a quality tool for adults, including people with
    Medicare. \[internet\]. Washington (DC): U.S. Department of Health
    and Human Services; 2005 \[updated 2008 Mar 27\]; \[accessed 2008
    May 22\]. This is available from the [Medicare Web
    site.](http://www.hospitalcompare.hhs.gov/) See the related
    [QualityTools](http://www.innovations.ahrq.gov/content.aspx?id=763)
    summary.

#### NQMC STATUS

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.

#### COPYRIGHT STATEMENT

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.

### Disclaimer

#### NQMC DISCLAIMER

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<http://www.qualitymeasures.ahrq.gov/about/inclusion.aspx>.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008