Welcome to Lesson 2 of 4 of this learning activity titled Mastering Performance Composite Measures. The content in this lesson was developed by Shelley Conine. I am Kate Malish, and I will be narrating this lesson. The objectives for Lesson 2 of 4 NCDR Overview of Mastering Performance Composite Measures include, define the composite performance measures, and describe individual performance measure calculations. The composite measures are comprised of multiple individual performance measures. The lighter blue dot represents one individual performance measure. There can be as many as 15 individual performance measures included in a performance composite. The overall AMI care summarizes the overall care provided to a myocardial infarction patient and consists of 15 individual performance measures. Metric 33, Aspirin at Arrival. Metric 48, Immediate Angiography after Cardiac Arrest. Metric 13, Door-to-Needle Time. Metric 37, First Medical Contact to Device Time. Metric 55, Door-In-Door-Out Time. Metric 56, Time to Primary PCI among Transferred Patients. Metric 17, Reperfusion Therapy. Metric 47, Early Troponin Measurement after NSTEMI. Metric 11, Evaluation of LV Systolic Function. Metric 12, ACE Inhibitor or ARB for LV Systolic Dysfunction at Discharge. Metric 34, Aspirin at Discharge. Metric 9, Beta Blocker at Discharge. Metric 36, High Intensity Statin at Discharge. Metric 46, P2Y12 Inhibitor at Discharge. Metric 21, Cardiac Rehabilitation Referral from an Inpatient Setting. The overall defect-free care consists of the same 15 individual performance measures as overall AMI care, however, reflects a different measurement methodology. Metric 33, Aspirin at Arrival. Metric 48, Immediate Angiography after Cardiac Arrest. Metric 13, Door-to-Needle Time. Metric 37, First Medical Contact to Device Time. Metric 55, Door-In-Door-Out Time. Metric 56, Time to Primary PCI among Transferred Patients. Metric 17, Reperfusion Therapy. Metric 47, Early Troponin Measurement after NSTEMI. Metric 11, Evaluation of LV Systolic Function. Metric 12, ACE Inhibitor or ARB for LV Systolic Dysfunction at Discharge. Metric 34, Aspirin at Discharge. Metric 9, Beta Blocker at Discharge. Metric 36, High Intensity Statin at Discharge. Metric 46, P2Y12 Inhibitor at Discharge. Metric 21, Cardiac Rehabilitation Referral from an Inpatient Setting. The STEMI Performance Composite is the specific measurement of care provided for the pre-arrival STEMI patient and consists of 12 individual performance measures. Metric 33, Aspirin at Arrival. Metric 48, Immediate Angiography after Cardiac Arrest. Metric 13, Door to Needle Time. Metric 37, First Medical Contact to Device Time. Metric 17, Reperfusion Therapy. Metric 11, Evaluation of LV Systolic Function. Metric 12, ACE Inhibitor or ARB for LV Systolic Dysfunction at Discharge. Metric 34, Aspirin at Discharge. Metric 9, Beta Blocker at Discharge. Metric 36, High Intensity Statin at Discharge. Metric 46, P2Y12 Inhibitor at Discharge. Metric 21, Cardiac Rehabilitation Referral from an Inpatient Setting. The NSTEMI Performance Composite is specific to the care of the NSTEMI patient and consists of 9 individual performance measures. Metric 33, Aspirin at Arrival. Metric 47, Early Troponin Measurement after NSTEMI. Metric 11, Evaluation of LV Systolic Function. Metric 12, ACE Inhibitor or ARB for LV Systolic Dysfunction at Discharge. Metric 34, Aspirin at Discharge. Metric 9, Beta Blocker at Discharge. Metric 36, High Intensity Statin at Discharge. Metric 46, P2Y12 Inhibitor at Discharge. Metric 21, Cardiac Rehabilitation Referral from an Inpatient Setting. The Acute AMI Performance Composite focuses on the care provided in the acute phase of a myocardial infarction and consists of 7 individual performance measures. Metric 33, Aspirin at Arrival. Metric 13, Door to Needle Time. Metric 37, First Medical Contact to Device Time. Metric 55, Door-In-Door-Out Time. Metric 56, Time to Primary PCI among Transferred Patients. Metric 17, Reperfusion Therapy. And Metric 47, Early Troponin Measurement after NSTEMI. The Discharge AMI Performance Composite denotes AMI care provided at discharge and consists of 7 individual performance measures. Metric 11, Evaluation of LV Systolic Function. Metric 12, ACE Inhibitor or ARB for LVSD at Discharge. Metric 34, Aspirin at Discharge. Metric 9, Beta Blocker at Discharge. Metric 36, High-Intensity Statin at Discharge. Metric 46, P2Y12 Inhibitor at Discharge. And Metric 21, Cardiac Rehabilitation Referral from an Inpatient Setting. It is important to understand how the individual performance measures are calculated prior to understanding the measurement methodologies of the performance composite measures. Each individual measure will have measure description. This is the who and or what being measured. Numerator is the number of occurrences of the item, element, or selection that meet the criteria. So, basically, it is the count of who and or what that meets the measure. Denominator is the total number of occurrences of the item, element, or selection that are eligible based on the criteria. It denotes who and or what that is being measured. Denominator exclusions or measure exclusions are those reasons that remove a patient from the denominator regardless of whether the numerator criteria is met. Patients are removed from the denominator regardless of whether the care measure was provided. Measure exceptions or measure exceptions are those conditions that remove a patient from the denominator only if the numerator criteria were not met. Patients are removed from the denominator when the care measure was not provided and there was a valid reason for the performance measure. This allows for a fairer measurement of quality for those providers with higher-risk populations and to defer to clinical judgment of the provider, thus individualized care. Not all measures will have denominator exceptions. The Writing Committee determined this measure-by-measure, citing that some measures, for example, patient safety, outweighs any denominator exception. Subject 34, Aspirin at Discharge, will demonstrate how the algorithms assess for the patient's eligibility for the individual performance measure. Understanding the process of how individual measures are calculated is the basis of understanding the eligible patient population and its impact on the composite measures. The denominator consists of patients with NSTEMI or pre-admit STEMI minus denominator exclusions of any of the following, which will remove the patient from the denominator regardless of whether the numerator is met. For metric 34, those denominator exclusions are left against medical advice, deceased during hospitalization, comfort measures only, hospice care, or transferred to other acute care hospital. Next, the algorithm assesses for patients who did not meet the numerator and valid reasons why the numerator is not met. Valid reasons are set by the metric and are called denominator exceptions. When a denominator exception is identified, it will remove the patient from the denominator. Numerator not met minus denominator exception. Metric 34 denominator exceptions include medical or patient reason for not prescribing aspirin at discharge, patients currently enrolled in a clinical trial precluding the use of aspirin in its protocol. An anticoagulant and a P2Y12 inhibitor were prescribed at discharge. Once all the calculations are complete, patients who remain in the denominator are the eligible patient population. The total eligible patients who received the care measure is the numerator. The denominator is the total eligible patient population. The numerator divided by the denominator equals the individual metric score. This concludes Lesson 2 of 4, Mastering Performance Composite Measures. Thank you for your participation.

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