1120 - Metric 34 | Aspirin at Discharge-1120 - Metric 34

Video Transcription

The Chest Pain MI Registry case scenario for November is reviewing metric 34, Aspirin at Discharge.  A 54-year-old female presents to the ED for chest pressure and shortness of breath. Her past medical history includes persistent atrial fibrillation and she is on dabigatran  at home. The cardiology consult provides a clinical diagnosis of NSTEMI after two troponin values were above 99% upper reference limit and a rise was demonstrated.  The patient was medically treated and discharged. Discharge medications included dabigatran 150 mg twice a day, clopidogrel 75 mg once  a day, metoprolol 12.5 mg twice a day, and atorvastatin 40 mg at bedtime. The abstractor coded the discharge medications as shown here.  Is the patient included in the denominator for metric 34, Aspirin at Discharge? Number one, no. Or number two, yes.  Please take a moment to review the documentation and the question.  The patient is not included in metric 34, Aspirin at Discharge. Let's look at the Executive Summary Measure and Metric Companion Guide for insight as to why.  Reasons why patients are not included in the denominator of an individual performance measure include, one, the patient is not eligible based on the criteria, two, the patient is  excluded per a denominator exclusion, three, the patient is excluded per a denominator exception.  This patient was not prescribed aspirin, though it is a guideline drug for their condition.  However, they were prescribed an anticoagulant, dabigatran, and a P2Y12 inhibitor, clopidogrel, meeting the exception criteria and removing the aspirin requirement.  Therefore, the exception will remove the patient from the denominator and deem this patient not eligible for this measure.  Now let us look at how this patient is displayed in the Individual Performance Measure and the Performance Composite Measures.  Patients who do not meet the denominator of an individual performance measure will not be listed in the patient-level detail report of that measure.  In this scenario, the patient will not be listed in metric 34, Aspirin at Discharge. Additionally, the patient-level detail report for the Composite Performance Measures will  be blank for Aspirin at Discharge. This is not punitive and will have no impact on the calculated score.  Thank you for viewing the Chest Pain MI Registry November case scenario reviewing metric 34, Aspirin at Discharge.

Video Summary

In this video, the presenter reviews a case scenario from the Chest Pain MI Registry for November. A 54-year-old female with a history of persistent atrial fibrillation and taking dabigatran at home presents to the emergency department with chest pressure and shortness of breath. The patient is diagnosed with NSTEMI and treated medically before being discharged. The discharge medications include dabigatran, clopidogrel, metoprolol, and atorvastatin. The video discusses whether the patient is included in metric 34, Aspirin at Discharge. It concludes that the patient is not included because although aspirin is a guideline drug, they were prescribed an anticoagulant and a P2Y12 inhibitor, meeting the exception criteria. This exception removes the patient from the denominator and deems them not eligible for the measure. The presenter also mentions that the patient will not be listed in the patient-level detail report or the Composite Performance Measures report for Aspirin at Discharge, but this has no impact on the calculated score.<br /><br />No credits were mentioned in the video.

Keywords

Chest Pain MI Registry

NSTEMI

dabigatran

clopidogrel

metoprolol