Transcript Acute Myocardial Infarction (Heart Attack)

Acute Myocardial Infarction
(Heart Attack)
Committee Membership:
B. Majcher, APRN, C. Mulhall, APRN, K. McLean, MD,
M. Jarotkiewicz MBA, M. Morrow, RN, MSN, PhD,
Nursing Staff of 3NEWS, CCU, 3 ITV, and Emergency
Room, Cardiac Cath Lab, Medical Records Department,
Center for Clinical Effectiveness.
• Since May 2002 Loyola University Medical Center (LUMC) has
been reporting performance on AMI Patients for Core Measures.
– These Core Measures, developed by the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) and the Center for Medicare and
Medicaid Services (CMS) were established to implement the best practice
guidelines for AMI patients.
– They are based on the American Heart Association (AHA) and the
American College of Cardiology (ACC).
Opportunity for Improvement
• Review of Acute Myocardial Infarction (AMI) Core Measures
data has shown that Loyola is meeting, or exceeding, the
University HealthSystem Consortium (UHC) and national rates
for most measures.
• However, LUMC mortality was above expected rates, according
to Core Measures risk adjustment methodology.
Solutions Implemented
• To understand the Core Measures risk adjustment methodology,
the AMI Core Measures cases were analyzed using the UHC risk
adjustment methodology, which is unrelated to the Core Measures
methods, for severity adjustment.
– This algorithm is currently employed at more than 100 Academic Hospitals
for clinical quality improvement efforts separate from the Core Measures
• This analysis showed a below expected mortality rate (favorable).
– The discrepancy between the two risk-adjustment models appeared to be
due to cases in which patients with non-cardiac illnesses were not being
adequately risk-adjusted within the Core Measures’ limited algorithm.
Solutions Implemented
• The AMI Core Measures Committee meets monthly to review
and to discuss mortality cases in order to understand and
improve AMI care.
• Following AMI patient discharge, all charts are assessed by a
cardiac case manager and a medical records coder for
appropriate inclusion in the measure set based on priority of
diagnoses.
– Physician review is included on all expired patients or when the
conclusion is unclear.
Solutions Implemented
• All AMI patients are seen by cardiac case managers for risk
factor reduction.
• On daily basis all AMI patients’ charts are being reviewed by
a cardiac case manager for any changes in patients’ severity,
medications and planned discharged date.
Acute Myocardial Infarction Mortality
14
12
10
Percent Mortality
8
6
4
2
0
LUMC Observed Mortality Rate
LUMC Expected Mortality Rate
National Morality Rate (Mean)
Quarter
Outcomes
• From Quarter 3 2005 through Quarter 3 2006, the observed
mortality at Loyola has dropped to a level far below the expected
levels as calculated by the Core Measures risk-adjustment model.
– This appears to be due to improved processes to ensure that cases are
appropriately included in these measures.
Next Steps
• Perform case level review of mortality cases at monthly AMI
Core Measures Committee meeting.
• Notify JCAHO/CMS of additional diagnoses and co-morbidities
absent from the risk-adjustment formula which can influence
AMI mortality risk.
• Continue to evaluate coding criteria of AMI patients.
Next Steps, other AMI Measures

The AMI Core Measures Committee will continue meeting on
monthly basis to address additional opportunities for improving
the care of AMI patients at Loyola.
• Involvement of a clinical pharmacist in order for the AMI patient
to receive the most benefit from the right medications during
hospital stay and at discharge.