Release Notes: Measure Information Form Version 2.

0 **NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Core Measure Set: Pneumonia (PN) Performance Measure Identifier: 14445 Performance Measure Name: (PN-4) Adult smoking cessation advice/counseling Description: Pneumonia patients with a history of smoking cigarettes who are given smoking cessation advice or counseling during hospital stay. Rationale: The publication Treating Tobacco Use and Dependence, Quick Reference Guide for Clinicians states that tobacco use has been cited as the single greatest cause of disease in the United States today. Smoking accounts for one out of every five deaths in the United States and is the most important modifiable cause of premature death. The above-mentioned Reference Guide for Clinicians also indicates that a high percentage of all smokers (at least 70%) have expressed a desire to quit smoking. Smoking cessation treatments ranging from brief clinician advice to specialist-delivered intensive programs, including pharmacotherapy, are not only clinically effective, but also are extremely cost-effective relative to other commonly used disease prevention interventions and medical treatments. Hospitalization can be an ideal opportunity for a patient to stop smoking, and smoking cessation may promote the patients medical recovery. Patients who receive even brief smoking-cessation advice from their physicians are more likely to quit than those who receive no counseling at all. Type of Measure: Process Improvement Noted as: An increase in the rate. Numerator Statement: Adult PN patients who receive smoking cessation advice or counseling during the hospital stay. Included Populations: Not applicable Excluded Populations: None Data Elements: Adult Smoking Counseling

Specifications Manual for National Implementation of Hospital Core Measures

PN-4-1

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Denominator Statement: Adult PN patients with a history of smoking cigarettes anytime during the year prior to arrival. ICD-9-CM Principal Diagnosis Code of pneumonia as defined in Appendix A, Table 3.1 OR ICD-9-CM Principal Diagnosis Code of septicemia as defined in Appendix A, Table 3.2 AND ICD-9-CM Other Diagnosis Code of pneumonia as defined in Appendix A, Table 3.1 OR ICD-9-CM Principal Diagnosis Code of respiratory failure as defined in Appendix A, Table 3.3 AND ICD-9-CM Other Diagnosis Code of pneumonia as defined in Appendix A, Table 3.1. AND Patients who have a history of smoking cigarettes within the year prior to admission. Included Populations: All adult PN patients including patients transferred from long term care facilities. Excluded Populations: Patients transferred to another acute care hospital Patients received in transfer from another hospitals emergency department Patients who left against medical advice Patients transferred to a federal hospital Patients discharged to hospice Patients who expired Patients who have no working diagnosis of pneumonia at the time admission Patients receiving Comfort Measures Only Patients less than 18 years of age Data Elements: Admission Date Adult Smoking History Birthdate Comfort Measures Only Discharge Status ICD-9-CM Other Diagnosis Codes ICD-9-CM Principal Diagnosis Code Pneumonia Working Diagnosis on Admission Transfer From Another ED Risk Adjustment: No

Specifications Manual for National Implementation of Hospital Core Measures

PN-4-2

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Data Collection Approach: Retrospective, data sources include administrative data and medical record documents. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal and other ICD-9-CM diagnosis codes, which require retrospective entry. Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency. If coding practices at the health care organization includes coding of smoking history with ICD-9-CM codes such as, 305.1, then programmers may want to include this in the measures algorithm so that hospitals, if they wish, can take advantage of this efficiency. Adult Smoking History: If the medical record indicates the patient is a non-smoker (or does not document the date the patient quit smoking), consider the patient a non-smoker who does not require smoking cessation advice/ counseling. If the medical record states the patient quit smoking within the past year, smoking cessation advice/counseling is indicated. If conflicting information is documented regarding cigarette smoking status, then assume or patient is a smoker. Measure Analysis Suggestions: For the data element Adult Smoking History, measurement systems may want to provide drill down information for analysis on the data element value of not documented or not assessed. This will enable the measurement system to provide health care organizations data on the number of patients where history of smoking is not on the patient record. Terminology: Comfort Measures Only: Commonly referred to as palliative care in the medical community and comfort care by the general public. Palliative care includes attention to the psychological and spiritual needs of the patient and support for the dying patient and the patients family. Pneumonia: Pneumonia is commonly defined as an acute infection of the pulmonary parenchyma that is associated with at least some symptoms of acute infection, accompanied by presence of acute infiltrate on chest radiograph or auscultatory findings consistent with pneumonia (such as altered breath sounds and/or localized rales) occurring in a patient not hospitalized. Nosocomial Infection: An infection acquired by a patient in a health care organization, especially a hospital. This infection is not present or incubating before admission to a hospital.

Specifications Manual for National Implementation of Hospital Core Measures

PN-4-3

Joint Commission No Unauthorized Distribution

Adult Smoking Counseling: Documentation indicating the patient received one of the following: Advice to stop smoking whether or not the patient is a current smoker; A viewing of a smoking cessation video; Brochures or handouts on smoking cessation; or A smoking cessation aid such as Nicoderm or Zyban. Adult Smoking History: Patients who have smoked cigarettes within the year prior to admission. Sampling: Yes; for additional information see the Sampling section. Age Groups: 18 years of age and older Data Reported as: Aggregate rate generated from count data reported as a proportion Selected References: Kikano GE, et al: The value of brief, targeted smoking-cessation advice. Family Practice Management. Pp. 50-2000. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department or Health and Human Services. Public Health Service. June 2000. The Smoking Cessation Clinical Practice Guideline Panel and Staff: The Agency for Health Care Policy and Research. Smoking Cessation Clinical Practice Guideline. JAMA, 275:1270-1280, 1996.

Specifications Manual for National Implementation of Hospital Core Measures

PN-4-4

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14445: (PN-4) Adult smoking cessation advice/counseling

Numerator: Denominator: Adult PN patients who receive smoking cessation advice or counseling during the hospital stay. Adult PN patients, with a principal discharge with a history of smoking during the year prior to hospital arrival.
Variable Key: Patient Age

Start

PN-4 A

Missing / Invalid

ICD-9-CM Principal Diagnosis Code

Not on Table 3.1

ICD-9-CM Principal Diagnosis Code

Not on Table 3.2

ICD-9-CM Principal Diagnosis Code

Not on Table 3.3

PN-4 B

On Table 3.1

On Table 3.2 On Table 3.3

PN-4 A

All Invalid

ICD-9-CM Other Diagnosis Codes

Missing or Not on Table 3.1

PN-4 B

On Table 3.1

PN-4 A

Missing / Invalid

Admission Date

Valid

PN-4 A

Missing / Invalid

Birthdate

Valid

PN-4 A

Missing / Invalid

Pneumonia Working Diagnosis on Admission

=N

PN-4 B

=Y PN-4 H

Specifications Manual for National Implementation of Hospital Core Measures

PN-4-5

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PN-4 H

Missing / Invalid

Comfort Measures Only

=Y

=N

Missing/ Invalid

Transfer From Another ED

=Y

(Initial population, common to all measures in the PN set)

=N

Patient Age (in years) = Admission Date minus Birthdate

Note: The algorithm to calculate age must use the month and day portion of admission date and birthdate to yield the most accurate age.

age is < 0 days (negative value)

Patient Age

age is > or = 0 days and<18 years

age is > or = 18 years

PN-4 A

Missing/ Invalid

Discharge Status

= 02, 07, 20, 41, 43, 50 or 51

PN-4 B

= 01, 03, 04, 05, 06, 08, 61, 62, 63, 64, 65

Missing or Invalid Measure Population Data

A
PN-4 Z

Missing/ Invalid

Adult Smoking History

= N or Z

Not In Measure Population

B
PN-4 Z

=Y

Missing or Invalid Numerator Data

Missing/ Invalid

Adult Smoking Counseling

=N

In Measure Population

=Y

PN-4 Z

In Numerator Population

E
Stop

Specifications Manual for National Implementation of Hospital Core Measures

PN-4-6

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