Core Measure: A Case Study
A core measure is a care requirement set by The Joint Commission (TJC) and The Centers for Medicaid Services (CMS) that is a vital part in improving the health care delivery process (The Joint Commission, 2016). Core measures are evidence-based, diagnosis specific, and target specific patient groups. They contain requirements covering assessments (things one needs to look, hear, see, and feel on patients), interventions (actions one must take), and documentation (charting requirements that are core measure specific). Core measures range from the outpatient to the inpatient settings. Some of the core measures one will see regularly are for Acute Myocardial Infarction, Stroke, Pneumonia, Heart Failure, and Smoking Cessation (Bay Medical Core Measures, 2016). The number of core measures is always changing and adapting to meet the care requirements set by TJC. Every year new core measures are added and old ones are either retired or modified as new evidence-based research surfaces. While researching for this paper, I became interested with Acute Myocardial Infarctions and just how quickly it can claim a life if not treated. While working at Bay Medical as a nurse intern in the ICU, I have seen numerous patients that have suffered from an AMI. Every year approximately 900,000 people in the US are diagnosed with AMI; among these, 225,000 will die, and an additional 125,000 will die without receiving any medical treatment (Comprehensive Review of Development for Core Measures, 2002). Treatment for AMI should begin immediately or as soon as possible. There
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are a lot of time specific interventions that need to be done when an individual is admitted with an AMI. The core measure and requirements for AMI include: ASA administered on arrival and prescribed at discharged, ACE or ARB for LVSD, beta-blocker prescribed at discharge, statin prescribed at discharge, fibrinolytic therapy received within 30 minutes of ER arrival, percutaneous coronary intervention (PCI) performed in less than 90 minutes after arrival to the hospital, and smoking cessation advice (The Joint Commission, 2016). One hospital uses the acronym BLAAST, as in “BLAAST those MIs” (Eckman et al., 2012). “The letters represented are as follows: B beta blocker, A aspirin, A ACE-I/ARB therapy, S smoking cessation, and T talk to your healthcare provider” (Eckman et al., 2012).
Statistics
Aspirin has been shown to decrease the risk of MI or stroke by 20-30% (Masica, Richter, Convery, & Haydar, 2009). It is very important that ASA is administered on arrival because it can help significantly reduce adverse events and mortality associated with AMI. ACE inhibitors reduce the risk of mortality by 10-20% and have their greatest effect on individuals with an EF of less than 40%, shown on echocardiogram (Masica et al., 2009). Beta-blockers are prescribed at discharge in an effort to prevent recurrent MI’s. Beta blockers help reduce the stress on ones heart by slowing the rate and decreasing the force with which the heart muscles contract to pump blood through the body (Atlanta Hospital, 2011). Beta-blockers have been shown to reduce the risk of death 13-23% (Masica et al., 2009). Administration of fibrinolytic therapy within thirty minutes of arrival to ER reduces the risk of death by 18% as compared to no treatment with fibrinolytics (Masica et al., 2009). If the patient is going to be undergoing PCI for a STEMI, current requirements support a door-to-balloon time of less than 90 minutes to prevent significant damage to the heart (Bay Medical Core Measures, 2016). When a patient comes in with an AMI, labs should be drawn to assess the patient’s lipids. Therapy with a statin drug (ex. Pravastatin) can the lower the risk of death by 12-20% and the risk of another MI by 20-30% (Masica et al., 2009). Lastly, education about smoking cessation if the patient is a frequent smoker is very important. It has been reported that smokers who stop smoking after having a heart attack lower their risk of death up to 40% (Masica et al., 2009). AMI is a very serious medical problem and should be treated immediately.
Patient education, along with prompt treatment with medications and interventions can contribute to saving someone’s life. Patients should be educated on compliance with the medications he/she is discharged home with from the hospital (ex. Aspirin, Statin, Beta-blocker). Compliance with the medication regimen will help in preventing another
MI.
Conclusion
Core measures are evidence-based, diagnosis-specific, and target specific patient groups in an effort to ensure the best possible patient outcomes. Every year core measures are constantly being modified to meet the current health care research. Out of all the current core measures, AMI stuck out to me because I have seen what this medical emergency can do to a person. I have also seen the medical measures taking to improve a patient’s situation first hand. Core measures are a great way to ensure that a patient is getting the best evidence-based care that leads to positive outcomes.
are a lot of time specific interventions that need to be done when an individual is admitted with an AMI. The core measure and requirements for AMI include: ASA administered on arrival and prescribed at discharged, ACE or ARB for LVSD, beta-blocker prescribed at discharge, statin prescribed at discharge, fibrinolytic therapy received within 30 minutes of ER arrival, percutaneous coronary intervention (PCI) performed in less than 90 minutes after arrival to the hospital, and smoking cessation advice (The Joint Commission, 2016). One hospital uses the acronym BLAAST, as in “BLAAST those MIs” (Eckman et al., 2012). “The letters represented are as follows: B beta blocker, A aspirin, A ACE-I/ARB therapy, S smoking cessation, and T talk to your healthcare provider” (Eckman et al., 2012).
Statistics
Aspirin has been shown to decrease the risk of MI or stroke by 20-30% (Masica, Richter, Convery, & Haydar, 2009). It is very important that ASA is administered on arrival because it can help significantly reduce adverse events and mortality associated with AMI. ACE inhibitors reduce the risk of mortality by 10-20% and have their greatest effect on individuals with an EF of less than 40%, shown on echocardiogram (Masica et al., 2009). Beta-blockers are prescribed at discharge in an effort to prevent recurrent MI’s. Beta blockers help reduce the stress on ones heart by slowing the rate and decreasing the force with which the heart muscles contract to pump blood through the body (Atlanta Hospital, 2011). Beta-blockers have been shown to reduce the risk of death 13-23% (Masica et al., 2009). Administration of fibrinolytic therapy within thirty minutes of arrival to ER reduces the risk of death by 18% as compared to no treatment with fibrinolytics (Masica et al., 2009). If the patient is going to be undergoing PCI for a STEMI, current requirements support a door-to-balloon time of less than 90 minutes to prevent significant damage to the heart (Bay Medical Core Measures, 2016). When a patient comes in with an AMI, labs should be drawn to assess the patient’s lipids. Therapy with a statin drug (ex. Pravastatin) can the lower the risk of death by 12-20% and the risk of another MI by 20-30% (Masica et al., 2009). Lastly, education about smoking cessation if the patient is a frequent smoker is very important. It has been reported that smokers who stop smoking after having a heart attack lower their risk of death up to 40% (Masica et al., 2009). AMI is a very serious medical problem and should be treated immediately.
Patient education, along with prompt treatment with medications and interventions can contribute to saving someone’s life. Patients should be educated on compliance with the medications he/she is discharged home with from the hospital (ex. Aspirin, Statin, Beta-blocker). Compliance with the medication regimen will help in preventing another
MI.
Conclusion
Core measures are evidence-based, diagnosis-specific, and target specific patient groups in an effort to ensure the best possible patient outcomes. Every year core measures are constantly being modified to meet the current health care research. Out of all the current core measures, AMI stuck out to me because I have seen what this medical emergency can do to a person. I have also seen the medical measures taking to improve a patient’s situation first hand. Core measures are a great way to ensure that a patient is getting the best evidence-based care that leads to positive outcomes.