Transcript 4QFY16 EPRP UPDATE.ppsx

EPRP UPDATE
4QFY2016
• The objectives of this presentation are:
• To provide an overview of changes to the questions and
definition/decision rules for 4QFY2016
• To acquaint you with scoring and exit report changes for
4QFY2016
Objectives
• As always, reviewing this presentation alone is not
sufficient to prepare for 4Q review.
• It is necessary to do a complete review of the highlighted
changes in 4Q question sets and draft exit report guides
Review the Question Sets!
CGPI
• There are some changes to the definition/decision rules
for q16 muscledx
• In addition to documentation found in progress notes,
documentation of myalgia, myositis, myopathy, or
rhabdomyolysis may also be accepted from the
allergy/adverse reaction drug reaction package.
• The date of allergy/adverse drug reaction documentation
may be greater than the past year.
• If there is documentation of an allergy/adverse drug reaction
to more than one statin medication, select value 1.
Validation Module
• There are changes to two questions in the Core Module
• q16 obesdx
• It is important to review the record for all of the diagnoses found
in this question; don’t stop looking just because you find one
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Diabetes
Obstructive sleep apnea
Hypertension (will auto-fill if selected in Validation module)
Hyperlipidemia/dyslipidemia
Degenerative Joint Disease
Metabolic syndrome
• The D/D rules contain important guidance for each diagnosis
Core Module
• Q17movetx: Weight management treatment
• For purpose of this question, clinician includes licensed
health care provider (e.g., physician/APN/PA, RN, LPN,
psychologist, registered dietician, rehabilitation therapist,
social worker) or health care provider who is under
supervision of the licensed health care provider.
Core Module
• q6 lfvdoc2
• Suggested data sources for finding documentation of the
patient’s left ventricular systolic function were added for
additional guidance
• Procedure notes
• Imaging notes
• Discharge Summaries; search for “echo”, “EF”, “LVEF”,
“LVSF”
CVD Module
• q6 kidisdx
• The definition/decision rules have been changed to
remind you to review the medical record to determine
if there is an active diagnosis of diabetic nephropathy
• The list of applicable diagnoses is included
Diabetes Module
• Suggested data sources have been added to two
questions in the OP Med Recon module
• q1 nexusrx: Clinic notes, physician orders
• q2 opmedrx: Clinic notes, ED/urgent care notes,
physician orders
• Physician orders are sometimes overlooked as an
important source for determining whether medications
have been prescribed or modified
Outpatient Medication Reconciliation
• There are several changes to the PI module including one
new question and definition/decision rule revisions
PI Module
• There are some changes to the influenza questions
• If q2 fluvac15 is answered 4, 98 or 99, you will receive a
warning message that asks you to look again for
documentation of an influenza immunization on a
specified date
• If you see the warning, please review pertinent data
sources again for documentation of influenza
immunization on the date given
Influenza
• q4 fluvac is a new question
• The intent of this question is to verify whether
influenza immunization documentation is located in
one of the listed data sources
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PCE Immunization
BCMA/MAR
Immunization Health Summary
Health Factors/Clinical Reminder
Clinic/progress/immunization note
Scanned notes
Other
Influenza Immunization Documentation
• q4 (fluvac)
• Please note: The priority list of data sources is not
representative of abstraction guidelines for fluvac15,
i.e. verification of influenza immunization
documentation found in clinical reminders/health
factors/health summary in the medical record
Influenza Immunization Documentation
• q4 (fluvac)
• To answer this question you will begin by looking in
PCE Immunization for documentation of influenza
immunization during the current flu season
• If documentation is found in this source, you will enter the
date of the documentation and go to the next question
(pnumovac)
• Note that the date of documentation may differ from the date
the influenza immunization was administered
Influenza Immunization Documentation
• q4 (fluvac)
• If you do not find the documentation in PCE
Immunization, look at source #2, BCMA/MAR
• Continue to look at each source in order until you find the
documentation
• After the source of the documentation has been identified
and the date entered, you will go on to the question
pnumovac
• If any listed sources are not familiar to you, please
consult with your Regional Manager for guidance
Influenza Immunization Documentation
• q9 tobscrdt
• As noted in the 2Q quality control message, the clinical
reminder may not reflect the most recent date of tobacco
use screening
• Review ALL notes and enter date of most recent
screening for tobacco use
Tobacco Screening
• q39 hpvtstdt
• Clarification regarding the date to enter for HPV test
date:
• Enter the date the most recent cervical HPV test was
performed (i.e., collected or obtained).
HPV Test Date
• q40 hpvrptdt
• Guidance for HPV report date:
• If the HPV report date cannot be entered (date is after pull
list date or after study end when study end date is greater
than pull list date), enter 99/99/9999.
HPV Report Date
• There are no changes to the Mental Health or Shared
Modules
No Changes
• There are a couple of changes to the CGPI exit report
and scoring
• Scoring for the influenza measures (p25h, p26h, p27 and
p19s) has a change
• Allerflu=1 will exclude only cases for which fluvac15= 98
or 99
• The Combined Cohorts report has been discontinued
• mrec41, mrec43, and fe9 will appear on the CGPI exit
report
CGPI Exit Report
HOSPITAL OUTPATIENT MEASURES
• There are no changes to the HOP questions or scoring
• HOP reminders from quality control findings:
• Arrival time is the earliest recorded time among the acceptable
sources.
• It is important that you review all the documented acceptable
times to determine the earliest. The time in CVP (past clinic
visits) is often the earliest time.
• Time of discharge from the ED may be documented in more than
one place. Enter the latest time that the patient received care in the
ED
• Look for documentation of the earliest documented time of direct
provider contact. Progress note start time does not indicate
direct provider contact
HOP
HBPC
• There are several changes to the HBPC instrument, many
of them based on the results of quality control findings
• Please take time to review the instrument carefully and be
sure you understand the rules for abstraction for each
question
HBPC
• q12 medrevdt
• Instruction has been added to enter the date of the most
recent medication management review
• It is not unusual to find more than one review of the
medication management plan during the specified
timeframe. Be sure to enter the date of the most recent.
medrevdt
• There are some important changes to the HBPC
medication education questions
Medication Education
• Please note: the questions starting with medrecdt are the
medication education questions and have nothing to do
with the series of questions about the medication
management plan
medrecdt
• q15 medrecdt replaces the former question medclindt
• Enter the date of the most recent HBPC face to face or
telephone encounter when medication reconciliation was
performed by a physician/APN/PA, pharmacist, or RN
during the past year
• It is important to read the definition/decision rules and
identify the correct date
• If there is no documentation of an HBPC face to face or
telephone encounter when medication reconciliation was
performed by a physician/APN/PA, pharmacist or RN
during the past year, enter 99/99/9999
medrecdt
• q16 newmedrx has some changes
• During the HBPC encounter on (computer to display
medrecdt) when medication reconciliation was performed, was
a new medication prescribed, added or identified during the
medication reconciliation process?
• A new medication is defined as any VA prescription, nonVA prescription, OTC or herbal/nutritional supplement
• that has been prescribed by a VA or non-VA provider or
started by the patient/caregiver and
• was prescribed at this visit or during the time period between
this visit and the next most previous HBPC visit where
medication reconciliation was performed by a HBPC
physician/APN/PA, pharmacist, or RN
newmedrx
• Important points for accurate abstraction of q16
newmedrx:
• A ‘new medication’ is one that has not been on the
patient’s medication list (active or expired) within the
past 90 days.
• A renewal of a medication previously prescribed in the
90 days prior to this encounter does not count as a new
medication
• If a new medication was prescribed, added or
identified, you will look for medication education as
before
newmedrx
• 4Q HBPC Exit Report/Scoring Changes
• hc22: Caregiver with Zarit Burden score of 8 or greater
and received appropriate intervention
• If the patient’s place of residence is unable to be determined
(ptreside=99) the case is excluded
• If the caregiver refuses screening (scrncare=98) the case is
excluded (change from fail)
• hc36: Home oxygen safety risk assessment within 30
days
• Changed from Pilot Indicator to Quality Indicator
HBPC Exit Report
INPATIENT INSTRUMENTS
• You will see some changes to all the Joint Commission
instruments in 4QFY16
• The changes are effective with 7/1/2016 discharges
• In some cases, there are also changes to the “pre”
instruments which are used to collect 4Q data for
discharges prior to 7/1/2016
• The definition/decision rules in the software will reflect
the rules appropriate for the discharge date of the case.
• Be sure to read the rules so you will abstract correctly!
Inpatient Instrument Changes
Discharge Months for 4Q Pull Lists
7/11/2016
8/8/2016
8/22/2016
Global
April and May
June
July*
HBIPS
May
June
July
HOP
May
June
July
Stroke
June
July
August
VTE
June
July
August
• *Note that there will be 4 Global Pull lists in 4Q
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This will allow abstraction to be closer to real time
In subsequent quarters there will be one Global list with each pull list rather than having 2 with the first list and
none with the last
4Q16 Discharge Months
• There are changes to the HBIPS instrument for discharges
both prior to and after 7/1/2016
HBIPS
• Changes to the HBIPS instrument that will be used to
collect data for the 7/11 and 8/8 pull lists:
• All of the continuing care plan questions have been
removed
• The Joint Commission retired the measures associated with
these questions effective 1/1/2016 however VHA elected to
continue to collect and score the data in 2Q and 3Q FY2016
• References to the continuing care plan in other questions
have also been removed
HBIPS “Pre”
• In addition to the removal of the CCP questions there are
a few other changes that will be effective with discharges
>= 7/1/2016 (8/22 pull list)
• The question asking for the time of discharge from
inpatient psychiatric care has been retired
• The refrnext question has been retired and is replaced by
a new question ptstatdc
• Note that refrnext is still applicable for discharges
<7/1/2016
4Q HBIPS
• q17 ptstatdc is a new question that replaces refrnext
• What was the patient’s status at the time the patient left the hospital based
inpatient psychiatric care setting?
• 1. The medical record contains documentation that the patient was
discharged from the hospital based inpatient psychiatric care setting and
hospital system at the same time
• 2. The medical record contains documentation of one of the following:
• the patient eloped and was discharged
• the patient failed to return from leave and was discharged
• the patient has not yet been discharged from the hospital
• the patient was discharged from the hospital to another level of care
outside of the hospital system from a setting other than the inpatient
psychiatric care setting
• 3. Unable to determine from medical record documentation
ptstatdc
• q17 ptstatdc definition/decision rules
• If the patient was in an acute-care hospital and had multiple
admissions to the psychiatric unit during the hospitalization,
this information should be abstracted at the time of
discharge from the hospital.
• In addition to the bulleted points, select value 2 when
• a patient checks out of a hospital against the advice of his
physician (AMA)
• a patient is released from a psychiatric inpatient stay directly
after a court hearing
ptstatdc
• Measures retired:
• ips4a-c
• ips5a-c
• ips7a-c
• Refrnext was replaced by ptstatdc in scoring ips6 for
discharges >= 7/1/2016.
• The changes are reflected in the 4Q exit report guide
HBIPS Exit Report
• There are changes to the Global instrument for discharges
both prior to and after 7/1/2016
Global Measures
• The Global instrument used to review the 7/11, 7/12 and
8/8 pull list (discharges <7/1/2016) will be the same as
the 3Q instrument with one exception
• Pneumococcal immunization data will no longer be
collected
• Imm1, 2 and 3 have been removed from the Global exit
report for discharges prior to 7/1/2016
Global Measures “Pre”
• There are several changes to the definition/decision rules
in the 4Q Global Measures instrument that are effective
with 7/1/2016 discharges (8/22 pull list)
• Again, it is critical to pay close attention to the
definition/decision rules as they appear in the software
since the rules will change from current rules when
abstracting the 8/22 pull list
Global Measures
• Acute Care Arrival Date and Time
• There are some additions to the ED record inclusion list
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Head CT scan report
CTA report
MRI report
MRA report
Arrival Date and Time
• Speaking of arrival time, we have noticed some common
mistakes made when abstracting this data element
• Please note these reminders:
• If the patient has two ED visits on the same day and is
admitted as a result of the second visit, use the arrival time
for the second visit, not the first
• If the patient is first seen in an OP clinic before arriving at
the ED, use the ED arrival time (acute care).
• ED note start times generally are not the arrival time
Arrival Time
• There are no changes to the ED departure time question
but please note these reminders:
• You are looking for the time the patient physically left the
ED such as
• Patient departed
• Check out time
• Transported to
• If you are not able to determine time of departure from the
ED enter 99:99
• The time the report was called to the nursing unit and the
time of admission or the admission order time are not
acceptable sources for ED departure time
ED Departure Time
• Tobstatus2 has changes
• The timeframe for screening has been changed to during the
first day of admission
• This includes the day of admission which is defined as day
zero and the day after admission which is defined as the first
day
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EXCEPTION:
• If the screening was performed prior to admission to the
psychiatric unit, i.e., at the transferring facility, in another
inpatient hospital unit, emergency department or observation unit,
the screening documentation must be present in the
psychiatric unit medical record.
Tobacco Screening
• tobstatus2 rule clarification
• Documentation of “nicotine” use is not acceptable to
determine tobacco use status
• The documentation of “nicotine” use needs to be supported
by language showing it was in the form of cigarettes, cigars,
pipes and/or smokeless tobacco
Tobacco Screening
• tobstatus2 rule clarification
• If there is documentation that the patient has used
smokeless tobacco AND has also smoked cigarettes daily
on average in a volume of five or more cigarettes (=> ¼
pack) per day and/or cigars daily and/or pipes daily
during the past 30 days, select Value “1.”
• There is no requirement to capture volume and frequency of
use for patients using only smokeless tobacco.
Tobacco Screening
• There are also changes to the rules for selecting value 97
(cognitive impairment) for tobstatus2
• Documentation that the patient cannot be screened for
tobacco use must be related to cognitive impairment during
the entire first day of admission
• If there is documentation within the first day of admission
that the patient was psychotic with documented symptoms,
e.g., hallucinating, non-communicative, catatonic, etc.,
which prevented them from answering questions reliably,
they would be considered cognitively impaired.
Tobacco Screening
• You may also select value 97 for tobstatus2 when
• there is documentation that the patient was intubated the
entire first day of admission, as the patient is unable to
answer
• there is documentation of any of the examples of cognitive
impairment during the first day of admission, regardless of
conflicting documentation.
Tobacco Screening
• There are several important changes to the question tobtxcoun
• Practical counseling may occur at any time during the
hospital stay and
• requires a one-on-one interaction with the patient to address at a
minimum the following three components:
• recognizing danger situations
• developing coping skills and
• providing basic information about quitting
• Giving the patient a pamphlet alone does not constitute
practical counseling even if it contains all three components
• More examples of coping skills and basic information about
quitting have been added
Practical Counseling
• tobtxmed
• You may select value 1 (yes) if you find documentation
that an FDA approved tobacco cessation medication was
administered during the hospital stay
• You are no longer limited to looking for the medications
during the first three days of admission only
Tobacco Cessation Medications
• Likewise for the question notobmed, you may look for a
reason for not administering FDA approved tobacco
cessation medications are documented anytime during
the hospital stay
• Documentation by a physician/APN/PA or pharmacist
must be explicitly documented or clearly implied
Reason For No Tobacco Medication
• Select value 2 (no) for notobmed
• when conflicting information for the indicated reasons for
not administering the tobacco cessation medications is
documented in the medical record
• if refusal is documented by the physician/APN/PA as the
reason for no tobacco cessation medication during the
hospitalization
Reason For No Tobacco Medication
• There are some clarifications in the rules for refoptob
• Quitline referral
• If the patient directly calls the Quitline during the
hospitalization, documentation must reflect that staff was
present during the call to verify that an appointment was set
Referral for OP Tobacco Counseling
• Refusal of referral
• Documentation of patient’s refusal of an offer of
outpatient tobacco cessation counseling referral during
the hospitalization is acceptable to select value 98
• Even if the patient refused practical counseling
(tobtxcoun = 98) during the hospitalization, a referral for
outpatient tobacco counseling must be offered.
• Select “99” if a referral was not offered at any time prior
to discharge
Referral for OP Tobacco Counseling
• tobmedc
• When determining whether tobacco cessation medication
was prescribed at discharge, all discharge medication
documentation should be reviewed
• If one source indicates tobacco cessation medication was
prescribed, select value 1 unless there is documentation
elsewhere in the medical record that suggests it was not
prescribed at discharge
Tobacco Meds at Discharge
• If the patient refused tobacco cessation medication during
the hospitalization, a prescription must be offered again at
the time of discharge
• Select Value “99” if documentation reflects that a
prescription for cessation medication was not offered at the
time of discharge
Tobacco Meds at Discharge
• Notobrxdc
• If the reason for not prescribing FDA-approved cessation
medication is documented at any time during the
hospitalization, additional documentation of the reason at
the time of discharge is not required
• Documentation by the physician/APN/PA or pharmacist
that the patient refused tobacco cessation medication is
not considered a valid reason for no tobacco cessation
medication at discharge. If refusal is documented as the
reason, select “2”
Reason for No Tobacco Meds at
Discharge
• Auditc
• The timeframe for screening for alcohol misuse using
the AUDIT-C remains within the first 3 days of
admission
• Otherwise, the changes to the definition/decision rules
mirror those in the tobacco screening question
• If the screening was performed prior to admission to the psychiatric unit, i.e.,
at the transferring facility, in another inpatient hospital unit, emergency
department or observation unit, the screening documentation must be present
in the psychiatric unit medical record.
• Changes re: cognitive impairment
Alcohol Screening
• The briefint question name was retired and is replaced
with a new question, briefintv
• Please note that the requirements for this question
differ from the previous question
• It is critical that you follow the definition/decision
rules for this question beginning with 7/1/2016
discharges
Brief Intervention
• Following the positive screening result for alcohol use, did the patient receive a
brief intervention prior to discharge?
•
1. The patient received a brief intervention including all of the following components:
• a. Concern that the patient is drinking at unhealthy levels known to increase his/her risk of
alcohol-related health problems
• b. Feedback linking alcohol use and health, including:
- Personalized feedback (i.e., explaining how alcohol use can interact with patient’s medical
concerns [hypertension, depression/anxiety, insomnia, injury, congestive heart failure (CHF),
diabetes mellitus (DM), breast cancer risk, interactions with medications])
OR
- General feedback on health risks associated with drinking.
• c. Advice to abstain (if there are contraindications to drinking)
OR
Advice to drink below recommended limits (specified for patient).
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98. Patient refused/declined brief intervention
99. Brief intervention was not offered to the patient during the hospital stay or unable to
determine if a brief intervention was provided from medical record documentation
Brief Intervention
• A brief intervention is a single session or multiple
sessions conducted by a qualified healthcare professional
following a positive screen for unhealthy alcohol use
• The qualified health care professional engages the patient
in a joint decision-making process regarding alcohol use
and plans for follow-up are discussed and agreed to
•
A qualified healthcare professional may be defined as a
physician, nurse, addictions counselor, psychologist, social
worker, or health educator with training in brief intervention
Brief Intervention
In order to select value 1, the brief intervention must
include all of the three listed components
Select value 99 if the documentation provided is not
explicit enough to determine if the intervention provided
contained the specific components or if it is determined that
the intervention does not meet the intent of the measure
Brief Intervention
• q1 revptmed
• There are two additions to the list of clinical staff
members who may perform medication reconciliation
• Resident physician
• Pharmacy technician
• Documentation of medication reconciliation done in the
Emergency Room or Urgent Care Clinic prior to
admission is acceptable
Inpatient Medication Reconciliation
• q7 medsame2
• An important clarification has been added:
• If discharge medications are contained in more than
one discharge instructions document, the discharge
medications list must be the same in all documents in
order to select “1.”
Inpatient Medication Reconciliation
• The Inpatient Medication Reconciliation measures will
appear on the Global Exit Report
• There are no changes to scoring
Inpatient Med Recon Scoring
• We expect to have cases flagged for Delirium Risk on 4Q
pull lists
• There have been no changes to the questions/rules
• Fe81 will appear on the Global exit report
• There are no changes
Delirium Risk
• Imm1, 2, and 3 have been retired
• Imm4: an ICD-10-CM code on table 12.9 is no longer a
passing condition
• Sub20 and 30: briefintv replaced briefint in scoring for
discharges >=7/1/2016
• Tob10, 20, 40: length of stay criterion for inclusion
changed from >3 to >1 for discharges >=7/1/2016
Global Exit Report
• As noted earlier, the Combined Exit Report has been
discontinued
• Fe81 and mrec42, 21 and 34 have been added to the
Global exit report
Global Exit Report
STROKE
• For discharges <07/01/2016 (7/11 pull list) the questions
and definition/decision rules will be the same as
3QFY2016
• The changes noted in the following slides will be
effective with discharges >= to 07/01/2016 which will
start with the 8/8 pull list
4Q Stroke
• There are changes to the definition/decision rules to
clarify acceptable documentation for the answers “yes”
and “no” to q14 ecarintv, elective carotid intervention
Elective Carotid intervention
• Acceptable documentation for “yes” to encarintv
• Patients with ICD-10-PCS procedure codes on Table 8.3
Carotid Intervention Procedures, if medical record
documentation states that the patient was admitted for the
elective performance of the procedure
• Patients who are sent to the hospital by their physician and
admitted for performance of a carotid intervention.
Elective Carotid intervention
• Acceptable documentation for “yes” to encarintv
• Patients admitted to the hospital for purposes of
performance of a carotid intervention and the intervention is
cancelled/postponed during the hospital stay.
• Patients who request admission to the hospital for
performance of a carotid intervention.
• Patients transferred to the hospital for purposes of surgical
evaluation for performance of a carotid intervention
• Please note the inclusion terms for
“elective”
Elective Carotid intervention
• The reasons for selecting “no” have been reformatted and
clarified but are basically the same as before
Elective Carotid intervention
• There are also some clarifications to the rules for
abstraction of the “last known well” series of questions:
q15 lstknwl; q16 lstknwldt; q17 lstknwltm
• Please review all highlighted sections carefully!
Last Known Well
• The following scenarios are additions to the list of reasons
to answer “yes” to q15 lstknwl:
• If the only Time Last Known Well is documented as a time
immediately before hospital arrival without a specific time range
in minutes, e.g., “symptoms started just prior to ED arrival.”
• If one physician documents a Time Last Known Well and another
documents time of symptom onset unknown.
• If physician documents a Time Last Known Well and nurse/EMS
documents Last Known Well unknown.
• If the physician documents Last Known Well as unknown and the
same physician crosses out unknown or mentions in a later note
that Last Known Well is now known with a time documented
Last Known Well
• There are also clarifications to the list of reasons to answer “no”
to q15 lstknwl
• Known Well is “UNKNOWN.” Documentation must explicitly state
that the Time Last Known Well is unknown/uncertain/unclear.
Documentation that time of symptom onset is
unknown/uncertain/unclear is also acceptable when Time Last
Known Well is not documented. If Last known Well is not
explicitly documented as unknown, do not make inferences (e.g.
do not assume that patient woke with stroke so Last Known Well
unknown unless explicitly documented).
• If one physician documents Last Known Well unknown and another
documents a Time Last Known Well.
• If there is no documentation that Last Known Well or stroke
signs/symptoms occurred prior to hospital arrival, but there is
documentation that Last Known Well first occurred after Arrival Time
(e.g., in-house stroke).
Last Known Well
• q17 lstknwltm
• Obviously, the definition/decision rules for abstracting this
data element are very lengthy
• It is important that you review the rules while you abstract,
particularly if the time documented is not straightforward
• Please review all the highlighted sections. A few are noted
as follows:
• The Time Last Known Well must be a time prior to the
patient’s Arrival Time.
• Do not use times after hospital arrival for Time Last Known
Well.
Time Last Known Well
• If the Time Last Known Well is documented as one
specific time and entered as Time Last Known Well on a
“Code Stroke” form or stroke-specific electronic
template, enter that time as the Time Last Known Well.
• Documentation of Time Last Known Well on a strokespecific form or template should be selected regardless of
other times last known well documented elsewhere in the
medical record
• Several exceptions to the above rule have been added
• It is important to review them carefully as you abstract
Time Last Known Well
• More Time LKW rules:
• Time Last Known Well on a Code Stroke Form may be
documented by a nurse.
• Code stroke form inclusion terms have also been added to the
rules
• If the time is noted to be “less than” a period of time prior
to ED arrival, assume the maximum range.
• Example: Time Last Known Well less than one hour ago.
Subtract one hour from the time of arrival to compute Time
Last Known Well.
Time Last Known Well
Q22 ynoivtpa
• There is an addition to the
list of reasons for not
initiating IV thrombolytic
therapy
• Documentation by a
physician/APN/PA that the
patient has “no neurological
deficit” or “normal
neurological exam” in the
emergency department
• Examples of
documentation that are
unacceptable as an
“other reason” have been
added
• Symptoms resolving”
• “No gait deficit”
• “Metastatic brain tumor
Reason for not initiating IV thrombolytic therapy
• q23 iviatpa
• If the patient received IV or IA thrombolytic therapy and
mechanical thrombectomy at this VAMC or within 24
hours prior to arrival, answer yes to this question
• A mechanical thrombectomy only does not count
IV or IA Thrombolytic Therapy
• q26 antithrom
• Lovenox has been removed as an example of
antithrombotic therapy medications
• Lovenox SQ for VTE prophylaxis (i.e. enoxaparin SQ 40
mg once daily; enoxaparin SQ 30 mg q12 hours) is not
sufficient for antithrombotic therapy.
• If no other antithrombotic therapy is administered by the
end of hospital day 2, select “No.
• Lovenox has also been removed from q35 dcanthrm
Antithrombotic Therapy
• q28 vtepro
• Graduated compression stockings (GCS) and aspirin have
been removed from the options for VTE prophylaxis
VTE Prophylaxis
• q29 oralxai
• edoxaban (Savaysa) is a new FDA approved drug added
to the list of oral factor Xa inhibitors
Oral Factor Xa Inhibitor
• The definition/decision rules for q44 ptedrsk have some
clarifications to the general guidance for discharge
instructions
• If educational materials in the form of discharge
instruction sheets, brochures, booklets, teaching sheets,
videos, CDs, DVDs or other patient-oriented materials
are used for stroke discharge education, documentation
must clearly convey that the patient/caregiver was given a
copy of the material to take home
• Providing a link to electronic materials is not sufficient
Stroke Discharge Instructions
• Any documentation of discharge instructions dated/timed
after discharge, except the discharge summary is not
acceptable
• If there is documentation that instructions were given or
sent to the patient/caregiver after discharge, select “No.”
• Reminder (not new):
• Use only documentation provided in the medical record
itself
• Do not review and use outside materials in abstraction
Stroke Discharge Instructions
• q41 ptedems
• Educational material addressing activation of the
emergency medical system must be linked to signs and
symptoms of stroke or TIA
• For example: “Call 911 immediately if you experience signs
or symptoms of stroke, such as sudden numbness or
weakness of an extremity.”
• Warning signs and symptoms of stroke include F.A.S.T.
(Face, Arms, Speech, Time)
Stroke Discharge InstructionsActivation of EMS
• q44 ptedrsk-stroke risk factors
• If individual risk factors are mentioned in the context of
education provided on the risk factors for stroke, then it
may be inferred that the education was personalized and
patient-specific.
• Educational material which addresses risk factors for
transient ischemic attack (TIA) is acceptable.
• Documentation of education which does not include stroke
and risk factors, select “No.”
• Examples:
• “Stroke binder given to patient’s family.”
• “Aneurysm education completed.”
Stroke Discharge Instructions-Risk Factors
• q45 ptedwarn
• Documentation of stroke education must include warning
signs of stroke or transient ischemic attack (TIA)
• Warning signs and symptoms of stroke include F.A.S.T.
(Face, Arms, Speech, Time)
• If documentation does not specifically address stroke/TIA
warning signs and symptoms, select no
Stroke Discharge Instructions-Warning Signs
• Stk1: VTE Prophylaxis
• GSC and Aspirin have been removed from the algorithm
• The report and scoring have been updated to reflect
discharges >=7/1/2016
Stroke Exit Report
VTE
• For discharges prior to 7/1/2016 (7/11 pull list), the “pre”
software will be utilized
• The only change from 3Q is that the ICU and Surgery
questions will not be applicable
• vte1 and vte2 are no longer on the exit report as they have
been retired
VTE “pre”
• There are several changes for 4Q VTE (discharges >=
07/01/2016) which you will see on the 8/8/16 pull list
• All of the Surgery and ICU questions were retired and are
no longer part of the instrument
• There are some minor wording changes/clarifications
• And there are also some important additions to the rules for
some questions
4Q VTE
• q12 vtetest
• Computed tomography (CT) Angiogram/Pulmonary
Angiogram of Chest has been added to the list of
applicable diagnostic tests
Diagnostic Tests for VTE
• q14 posvte
• There are several changes/clarification to the
definition/decision rules for this question
• Some are minor wording changes/clarifications
• There are also some new rules
Confirmed Diagnosis
• New definition/decision rules for q14 posvte
• If there is physician/APN/PA documentation that the patient
had a VTE, select “Yes”.
• If conflicting documentation between providers is present,
select “Yes.”
• If the record indicates ONLY a radiology report, and that report is
questionable regarding whether the patient had a VTE, select
“No”.
Q14 posvte
• New definition/decision rules for documentation in
sources other than radiology reports:
• The physician/APN/PA documentation must reflect the
time frame within four calendar days prior to arrival or
anytime during hospitalization.
• The physician/APN/PA documentation must indicate
the clinician’s confirmation of an acute VTE.
Q14 posvte
• edoxaba (Savaysa) has been added to the to Oral factor
Xa inhibitor list in the definition/decision rules in several
questions
Oral Factor Xa Inhibitor
• vte1 and vte2 have been discontinued
• There are no scoring changes for the remaining measures
VTE Exit Report
• Don’t forget to look at the Frequently Asked Questions
that are available in the software for each instrument
• While we always encourage you to consult with your
Regional Manager when you have questions, the FAQs
are a valuable resource that may be helpful as well
FAQs
• The key to accurate abstraction is reading and
following the definition/decision rules
• No matter how well you think you know the rules, it is
important to read them as you abstract
• Documentation is not always clear…if you are not certain
whether the documentation meets the intent of the
questions/rules, ask your Regional Manager for guidance
Accurate Abstraction
It is critical that we are
all on the same page
and the rules are
uniformly applied in
order to provide the
best quality data!
Accurate Abstraction