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Percent of hospitalized pneumonia patients with chest imaging confirmation

CBE ID
4440e
Endorsement Status
1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
No
Next Maintenance Cycle
Spring 2029
1.6 Measure Description

The chest imaging-confirmed measure of pneumonia diagnosis is a process measure of inpatient hospitalizations that identifies the proportion of adult patients hospitalized patients with a discharge diagnosis of pneumonia and who received systemic or oral antimicrobials at any time during admission who received chest imaging that supported the diagnosis of pneumonia, as recommended by clinical practice guidelines.  The measure applies to a target population of adult hospitalized patients.

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.10 Measure Rationale

As the leading infectious cause of death in the United States, the leading source of sepsis, and one of the most common reasons for adult hospitalizations, pneumonia is an important target for quality measurement and improvement. Prior measures of quality in pneumonia have driven important improvements for timely treatment and improved outcomes. However, past measures have also been challenged by difficulties in ensuring a consistent target population due to the subjectivity of diagnosis and the burden of manual chart review.

 

There are no gold standard criteria for the diagnosis of pneumonia, and signs and symptoms that are suggestive of pneumonia can overlap with other diagnoses. The presence of an infiltrate on chest imaging is the clinical sign that carries the most face validity as an objective verification of the diagnosis. Clinical practice guidelines strongly recommend verification of a pneumonia diagnosis with chest imaging. Confirmation of a diagnosis of pneumonia with chest imaging has been suggested as a performance metric by US professional societies and is listed as a practice standard in the United Kingdom. The availability of chest imaging is universal in US hospitals and is integrated into modern EHR's in searchable format to support clinical operations. Despite its availability, however, 10-30% of patients diagnosed with pneumonia lack positive chest imaging. With advances in the electronic medical record, an electronic Clinical Quality Measure that identifies chest imaging confirmation of diagnoses of pneumonia would 1) improve diagnostic accuracy in pneumonia, and 2) serve as an eCQM-based foundation for all quality measures in pneumonia.

 

The eCQM for diagnostic quality in pneumonia also balances with other current quality efforts, including reducing costs and improving 30-day mortality for pneumonia hospitalizations, reducing inappropriate antibiotics for bronchitis, and improving timely treatment and outcomes for sepsis. All of these measures could promote over-diagnosis of pneumonia, since patients without radiographic abnormalities are more likely to represent bronchitis, a disease with generally better outcomes, and for which clinicians are increasingly encouraged to avoid antibiotic use. Reporting the proposed eCQM in conjunction with the existing quality measures would promote meaningful quality improvement by ensuring accurate target populations and reporting. 

1.20 Types of Data Sources
1.25 Data Source Details

Electronic health record (EHR) data from inpatient hospital admissions, including discharge diagnosis codes, pharmacy and medication administration, and imaging records. These data are all collected routinely during usual clinical care through the process of inpatient hospitalizations.

 

Value sets defining these four concepts are available in the value sets (OIDs: 2.16.840.1.113762.1.4.1264.21; 2.16.840.1.113762.1.4.1264.1; 2.16.840.1.113762.1.4.1264.12; 2.16.840.1.113762.1.4.1264.8) and in the data dictionary attachment (Spreadsheet Names: “VSACAbnormalFindingChestImaging”, “VSACChestImagingforPneumoniaGrp”, “VSACInpatientPneumoniaDiagnosis”, “VSAC_SystemicAntimicrobials”). If a hospital system does not map abnormal chest imaging codes within their workflow, there are several tools either available or under development to extract evidence of pneumonia including structured reporting,1 natural language processing from chest imaging reports2,3 and image processing directly applied to images.4-6 For this proposal, we developed and validated a rule-based natural language processing tool that has been made publicly available for use (see Feasibility and Validity sections below for details). The full list of references cited throughout the full submission responses are provided at the end of our response to item 2.2 Evidence of Measure Importance