The Joint Commissions Core Measures serve as a standardized assessment measure for care given in specific areas.  Despite widespread dissemination of the core measures, safety goals, and related quality guidelines, there is significant variation in their application across hospitals.  The reasons for this are varied but include differences in guideline familiarity, provider training, and tools and systems to ensure that recommended care is provided and documented.   Also hospital type, size, and location have been found to correlate with compliance rates.   Other hospital characteristics such as physician leadership and organizational support also appear to contribute to the consistent use of evidence-based processes of care. (Andrew L. Masica, Richter, MS, MFA, ELS, Convery, MD, MMM, CPE, & Haydar, MD, MBA, 2009)

It is suggested that one reason for lack of compliance with core measures is a lack of awareness linking the evidence connecting processes of care to improved outcomes.  It has been found that compliance with core measures increases when staff is educated about the evidence supporting these measures.

We will now look at the evidence behind the Core Measure Set for Acute MI’s

CORE MEASURE/SAFETY GOAL	IMPACT ON PATIENT OUTCOMES
PTCA within 90 minutes	20% mortality reduction compared with thrombolytics
Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival	18% mortality reduction compared with no treatment
Beta-blockers prescribed at discharge	18% mortality reduction
Aspirin on arrival and prescribed at discharge	25% reduction in stroke, myocardial infarction, or death
ACE inhibitors if EF <40%	20% mortality reduction
Smoking cessation	40% mortality reduction
Statin prescribed at discharge	16% mortality reduction and 25% reduction in recurrent myocardial infarction

(Andrew L. Masica, Richter, MS, MFA, ELS, Convery, MD, MMM, CPE, & Haydar, MD, MBA, 2009)

Acute Myocardial Infarction Core Measure Set 

Set

Measure

ID #         Measure Short Name

AMI-1      Aspirin at Arrival

AMI-2      Aspirin Prescribed at Discharge

AMI-3      ACEI or ARB for LVSD

AMI-4      Adult Smoking Cessation Advice/Counseling*

AMI-5      Beta-Blocker Prescribed at Discharge

AMI-7      Median Time to Fibrinolysis

AMI-7a    Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival        

AMI-8      Median Time to Primary PCI

AMI-8a    Primary PCI Received Within 90 Minutes of Hospital Arrival

AMI-9      Inpatient Mortality (retired effective 12/31/2010)

AMI-10    Statin Prescribed at Discharge@

 

*denotes Non-accountability Measure

@denotes Accountability evaluation pending

 

When reviewing a case involving an Acute Myocardial Infarction I utilize the Joint Commission Core Measures to determine if there was any lack of following these measures with this particular patient.  If I find that the Core Measures were not adhered to I may then ask for the hospitals education files for the staff involved regarding Joint Commission Core Measures.  Nurses should be proactive with the patients in their care in making sure that the appropriate medications are given and prescribed at discharge.

If you have a case involving an Acute Myocardial Infarction Alvin & Associates, Legal Nurse Consultants would be happy to assist you with a review of your case.

Works Cited

Andrew L. Masica, M. M., Richter, MS, MFA, ELS, K. M., Convery, MD, MMM, CPE, P., & Haydar, MD, MBA, Z. (2009, April 22). Linking Joint Commission inpatient core measures and National Patient Safety Goals with evidence. Retrieved August 8, 2013, from US National Library of Medicine, National Institute of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666853/