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The Importance of EHR Quality Measures & Ischemic Vascular Disease


John is 67 years old and smokes heavily and is being treated for hypertension, diabetes, and hyperlipidemia. One evening John rapidly noticed weakness and decreased sensation on his right side. His family reported that he also seemed to have difficulty forming sentences. Within a minute the symptoms were most acute, and then began to spontaneously abate 5 minutes later. John arrived at the emergency room within 30 minutes and his clinical deficits had largely resolved with the exception of right hand clumsiness. Forty minutes after presentation, all of his symptoms were completely resolved. John followed up with his primary care physician to discuss his recent transient ischemic attack.1

Which Ischemic Vascular Disease Quality Measures Count for Stage 1 Meaningful Use?

  • Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic (NQF# 0068)
  • Ischemic Vascular Disease (IVD): Blood Pressure Management (NQF# 0073)
  • Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL Control (NQF# 0075)

Which Ischemic Vascular Disease Quality Measures Count for Stage 1 & 2 2014 Meaningful Use?

Measuring & Improving Ischemic Vascular Disease Care: A Real Impact on Your Patients

  • A meta-analysis of antiplatelet therapy among patients at high risk for occlusive vascular events found absolute reductions in the risk of developing a serious vascular event in:2
    • 3.6% in patients with previous stroke or transient ischemic attack treated over 2 years
      • For every 100 of these patients given antiplatelet therapy, 3 serious vascular events are prevented every 2 years
  • A systematic review of the effectiveness of lowering blood pressure in preventing recurrent vascular events in patients with previous stroke or transient ischemic attack, with an follow-up period of 2 to 5 years, showed that in comparison with those who did not receive antihypertensive therapy, those who did receives such treatment were:3
    • 24% less likely to have a stroke,
    • 21% less likely to have a myocardial infarction, and
    • 21% less likely to have any kind of vascular event.
  • A meta-analysis of randomized trials comparing the risk of major vascular events in those with statin therapy compared to a control, with a median follow-up period of 4.8 years, found that for every 38 mg/dl reduction in LDL-C there is a:4
    • 20% reduction in risk for ischemic stroke.

Conclusion

Close attention to the quality measures related to ischemic vascular disease can help John spend less time in the hospital due a life-threatening vascular event, and more time quality with his family.

Clinical Quality Measure Information

Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic

NQF# Description Numerator Denominator Exclusions
0068 Percentage of patients who have documentation of use of aspirin or another antithrombotic All patients:
  • With appropriate documentation of use of aspirin of antithrombotic
Systematic sample of patients with:
  • Age > 18 years, &
  • Ischemic Vascular Disease
  • None

Ischemic Vascular Disease: Blood Pressure Management

NQF# Description Numerator Denominator Exclusions
0073 Percentage of patients whose most recent blood pressure reading was <140/90 mmHg All patients:
  • Whose most recent blood pressure reading was <140/90 mmHg
Systematic sample of patients with:
  • Age > 18 years &
  • Ischemic Vascular Disease
Patients With:
  • < 1 office visit in the last 12 months
  • Self-reported blood pressure

Ischemic Vascular Disease: Complete Lipid Profile and LDL Control < 100

NQF# Description Numerator Denominator Exclusions
NQF# Not Applicable Percentage of patients with a full lipid profile and percentage of those patients with LDL-C <100 All patients:
  • 1) With a date documented for each component of the lipid profile
  • 2) With LDL < 100mg/dl
Systematic sample of patients with:
  • Age > 18 years &
  • Ischemic Vascular Disease
Patients With:
  • Self-reported LDL-C
  • <12 months of physician care for IVD

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.5

  1. Adapted from online Transient Ischemic Attack Common Vignette https://online.epocrates.com/noFrame/showPage.do?method=diseases&amp;MonographId=107&amp;ActiveSectionId=22 Exit Disclaimer [online.epocrates.com]. Accessed 01.04.12.
  2. Antithrombotic Trialists' Collaboration. "Collaborative meta-anlaysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients". BMJ. 324 (2002): 71-86.
  3. Rashid, P., Leonardi-Bee, J., Bath, P. "Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events: A Systematic Review". Stroke. 34 (2003): 2741-48.
  4. Cholesterol Treatment Trialists Collaboration. "Efficacy and safety of more intensive lowering of LDL cholesterol; a meta-analysis of data from 170,000 participants in 26 randomised trials". Lancet. 376 (2010): 1670-81.
  5. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup - February 14, 2013

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