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Appropriate Care

The Appropriate Care Measure (ACM) is a patient-centered composite score that measures whether patients received all of the recommended treatments based on their specific conditions. Since each patient is unique and may not be eligible for every type of care for a condition, the ACM scores account for individual differences by examining each patient's care, one episode at a time. Only patients who received all of the appropriate and recommended care count toward the score.

The Appropriate Care Measures include an Overall ACM score and seven topic-specific scores – heart attack, heart failure, pneumonia, surgical care and infection prevention (SCIP), immunization, stroke, and venous thromboembolism (VTE) care. As of January 1st, 2014, the Overall ACM score consists of 25 measures (two heart attack, one heart failure, one pneumonia, six SCIP, two immunization, eight stroke, and five VTE).

Since its creation, ACM methodology has been revised on several occasions to include the most clinically relevant measures necessary to evaluate hospital performance. For hospital discharges in 2013, the Overall ACM comprised of 32 measures, including four heart attack, three heart failure, two pneumonia, eight SCIP, two immunization, eight stroke, and five VTE measures. Most recently, beginning with the first 2014 reporting period, the ACM methodology was adjusted to remove 7 retired and voluntarily reported measures. For a full list of all historical ACM methodology changes, please contact PHCQA.

Each hospital patient diagnosed with one of the seven above-mentioned clinical topics who is eligible for at least one of the measured treatments will be counted in the topic specific ACM score. If the patient enters the hospital exhibiting more than one of the seven clinical conditions, then the patient will only be counted as a denominator for the primary condition that caused the hospital admission. At the end of the given time period, the number of patients that received all of the proper treatments for their clinical condition will be divided by the total number of patients entering the hospital with that condition and eligible for at least one of the treatments. This will produce each topic-specific ACM score. The Overall ACM score is calculated by adding all of the "numerators" for the seven clinical categories and dividing that sum by the total number of patients entering the hospital that were eligible for at least one of the 32 treatments indicated in the measure.

Measures in this Category

Overall Appropriate Care:  Total percentage of heart attack, heart failure, pneumonia, surgical care, stroke, venous thromboembolism, and at-risk patients who received all recommended treatments and preventive measures based on their clinical condition.

Heart Attack Care:  Percent of heart attack patients who received all recommended treatments based on their clinical condition.

The following is the list of the two underlying measures that make up the Heart Attack Appropriate Care Measure:

  • Fibrinolytic Therapy within 30 Minutes:  Percent of heart attack patients given fibrinolytic medication within 30 minutes of arrival to the hospital. (Source: CMS)
  • PCI within 90 Minutes:  Percent of heart attack patients receiving Percutaneous Coronary Intervention (PCI) during the hospital stay within 90 minutes of arrival to the hospital. (Source: CMS)

Heart Failure Care:  Percent of heart failure patients who received all recommended treatments based on their clinical condition.

The Heart Failure Appropriate Care Measure consists of one measure:

  • Evaluation of LVS Function:  Percent of heart failure patients receiving an evaluation of left ventricular systolic (LVS) function. (Source: CMS)

Pneumonia Care:  Percent of pneumonia patients who received all recommended treatments based on their clinical condition.

The Pneumonia Appropriate Care Measure consists of one measure:

  • Initial Antibiotic Selection:  Percent of immunocompetent patients with pneumonia who received an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines. (Source: CMS)

Surgical Care:  Percent of surgical care patients who received all recommended treatments based on their clinical condition.

The following is the list of the six underlying measures that make up the Surgical Care Appropriate Care Measure:

  • Beta Blocker during the Perioperative Period:  Percent of surgery patients who were taking heart drugs called beta blockers before coming to the hospital and were kept on the beta blockers during the period just before and after their surgery. (Source: CMS)
  • Prophylactic Antibiotic within 1 hour of incision:  Percent of Surgical patients who received prophylactic antibiotics within 1 hour prior to surgical incision. (Source: CMS)
  • Prophylactic Antibiotic Selection for Surgical Patients:  Percent of Surgical patients who received the appropriate prophylactic antibiotic(s) for their surgery. (Source: CMS)
  • Prophylactic Antibiotic Discontinued within 24 hours:  Percent of surgical patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time. (Source: CMS)
  • Urinary Catheter Removal within Two Days of Surgery:  Percent of surgical patients with urinary catheter removed on postoperative day 1 or postoperative day 2 with the day of surgery being day zero. (Source: CMS)
  • VTE Received within 24 Hours of Surgery:  Percent of surgery patients who received treatment to prevent blood clots within 24 hours before or after surgery when appropriate. (Source: CMS)

Preventive Care:  Percent of at-risk patients who received all recommended screenings and immunizations based on their clinical condition.

The following is the list of the two underlying measures that make up the Preventive Care Appropriate Care Measure:

  • Pneumococcal Immunization: Percent of high risk patients who were screened for receipt of pneumococcal vaccine (PPV23) and were vaccinated prior to discharge if indicated. (Source: CMS)
  • Influenza Immunization: Percent of acute care hospitalized inpatients of age 6 months and older who were screened for seasonal influenza immunization status and were vaccinated prior to discharge if indicated. (Source: CMS)

Stroke Care:  Percent of stroke patients who received all recommended treatments based on their clinical condition.

The following is the list of the eight underlying measures that make up the Stroke Care Appropriate Care Measure:

  • VTE Prophylaxis for patients with ischemic or hemorrhagic stroke:  Percentage of patients with ischemic or hemorrhagic stroke who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or day after hospital admission. (Source: CMS)
  • Ischemic Stroke patients discharged on antithrombotic therapy:  Ischemic stroke patients who were prescribed antithrombotic therapy at hospital discharge. (Source: CMS)
  • Anticoagulation therapy for atrial fibrillation/flutter:  Percentage of patients with both an ischemic stroke and atrial fibrillation/flutter who were prescribed anticoagulation therapy at hospital discharge. (Source: CMS)
  • Thrombolytic therapy for acute ischemic stroke patients:  Acute ischemic stroke patients who arrived at the hospital with 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well. (Source: CMS)
  • Thrombolytic therapy by end of day two:  Ischemic stroke patients administered antithrombotic therapy by the end of hospital day two. (Source: CMS)
  • Discharged on statin medication:  Ischemic stroke patients with LDL ≥ 100 mg/dL,or LDL not measured, or who were on cholesterol reducing therapy prior to hospitalization are prescribed statin medication at discharge.
  • Stroke education:  Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during their hospital stay explaining the activation of the emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. (Source: CMS)
  • Assessed for rehabilitation services:  Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services. (Source: CMS)

Venous Thromboembolism Care:  Percent of venous thromboembolism patients who received all recommended treatments based on their clinical condition.

The following is the list of the five underlying measures that make up the Venous Thromboembolism (VTE) Care Appropriate Care Measure:

  • VTE Prophylaxis:  Number of patients who received VTE prophylaxis or have documentation why VTE prophylaxis was not given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission. (Source: CMS)
  • Intensive Care Unit VTE Prophylaxis:  Number of patients who received VTE prophylaxis or have documentation why VTE prophylaxis was not given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer). (Source: CMS)
  • VTE Patients with Anticoagulation Overlap Therapy:  Number of patients diagnosed with confirmed VTE who received an overlap of parenteral anticoagulation and warfarin therapy. (Source: CMS)
  • VTE Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or Nomogram:  Number of patients diagnosed with confirmed VTE who received intravenous Unfractionated Heparin therapy dosages and had their platelet counts monitored using defined parameters such as a nomogram or protocol. (Source: CMS)
  • VTE Discharge Instructions:  Number of patients diagnosed with confirmed VTE that were discharged to home, home care, court/law enforcement or home on hospice care on warfarin with written discharge instructions. (Source: CMS)