This measure estimates a hospital-level 30-day, all-cause, risk-standardized mortality rate (RSMR) for patients discharged from the hospital with a principal discharge diagnosis of acute myocardial infarction (AMI). The outcome is all-cause 30-day mortality, defined as death from any cause within 30 days of the index admission date, including in-hospital death, for AMI patients. The target population is Medicare Fee-for-Service beneficiaries who are 65 years or older.
This Hybrid AMI mortality measure was developed de novo. This measure is harmonized with the Centers for Medicare and Medicaid Services’ (CMS’s) current publicly reported claims-only measure, hospital 30-day, all-cause, risk-standardized mortality rate (RSMR) following acute myocardial infarction (AMI) (NQF #2473). The measure is referred to as a hybrid because it is CMS’s intention to calculate the measure using two data sources: Medicare fee-for-service (FFS) administrative claims and clinical electronic health record (EHR) data.
The outcome is all-cause 30-day mortality, defined as death from any cause within 30 days of the index admission date, including in-hospital death, for patients with a principal discharge diagnosis of AMI.
Denominator
1.15 Denominator
The cohort includes inpatient admissions for Medicare FFS patients 65 years and older who were discharged from non-federal, short-term, acute care hospitals with a principal discharge diagnosis of AMI.
Additional details are provided in S.7 Denominator Details.
Exclusions
Exclusions
The mortality measure excludes index hospitalizations that meet any of the following exclusion criteria:
1. Discharged alive on the day of admission or the following day, who were not transferred to another acute care facility; 2. With inconsistent or unknown vital status or other unreliable demographic (age and gender) data; 3. Enrolled in the Medicare hospice program any time in the 12 months prior to the index admission, including the first day of the index admission; or 4. Discharged against medical advice (AMA).
After exclusions #1-4 are applied, the measure randomly selects one index admission per patient per year for inclusion in the cohort so that each episode of care is mutually independent with the same probability of the outcome. Additional admissions within that year are excluded. For each patient, the probability of death increases with each subsequent admission and therefore the episodes of care are not mutually independent. For the three-year combined data, when index admissions occur during the transition between measure reporting periods (June and July of each year) and both are randomly selected for inclusion in the measure, the measure includes only the June admission. July admissions are excluded to avoid assigning a single death to two admissions.
Measure Record
Most Recent Endorsement Activity
Measure Retired and Endorsement Removed Cardiovascular Spring Cycle 2018
Public Comments