JCI I-AMI-1 ASA On Arrival Specifications SAMPLE 2012

Version 2.
Joint Commission
International
Acute Myocardial Infarction
(I-AMI) Measure Set
Use Ctrl + Home keys to go to the title page

Specification Manual for the Joint Commission International Library of Measures
Version 2.0, effective for January 2013 discharges (1st Quarter 2013)
2011 Joint Commission International
Version 2.0
Contents
I-AMI Hospital Inpatient Quality Measures ....................................................................................2
I-AMI Data Element/Variable List ..................................................................................................4
I-AMI Initial Eligible Patient Population Criteria..............................................................................5
I-AMI Initial Eligible Patient Population Word Algorithm.................................................................6
Measure Information Forms (including Information Forms, Overviews, Details, References,
Flowcharts, Word Algorithms, and Appendices)
I-AMI-1: Aspirin on Arrival ..................................................................................................7
I-AMI-2: Aspirin Prescribed at Discharge .................................................................................... 15
I-AMI-3: ACEI of ARB for LVSD .........................................................................................22
I-AMI-4: Adult Smoking Counseling ...................................................................................33
I-AMI-5: Beta Blocker Prescribed at Discharge ..................................................................41
I-AMI-9: Inpatient AMI Mortality .........................................................................................48
Appendix A: International Classification of Diseases (ICD) Code Tables ...........................55

Version 2.0
Joint Commission International Acute Myocardial Infarction (I-AMI)

Hospital Inpatient Quality Measures
I-Acute Myocardial Infarction (I-AMI)
Measure Code
I-AMI-1
Measure Short Name

Aspirin at Arrival
I-AMI-2
Aspirin Prescribed at Discharge
I-AMI-3
ACEI or ARB for LVSD
I-AMI-4
Adult Smoking Cessation

Advice/Counseling
I-AMI-5
Beta Blocker Prescribed at

Discharge
I-AMI-9
Inpatient Mortality
Measure Description
Aspirin received within 24 hours of arrival to
the hospital for patients having an Acute
Myocardial Infarction (AMI).
Aspirin prescribed at discharge for patients
who had an Acute Myocardial Infarction
(AMI).
ACEI (Angiotensin Converting Enzyme
Inhibitor) or ARB (Angiotensin Receptor
Blocker) for patients who have LVSD (Left
Ventricular Systolic Dysfunction) after
having an Acute Myocardial Infarction.
Adult Smoking Cessation (cigarette)
advice/counseling given to patients who
had an Acute Myocardial Infarction.
Beta blocker prescribed at discharge for
patients who had an Acute Myocardial
Infarction (AMI).
Acute Myocardial Infarction (AMI) patients
who expire during the hospital stay

Version 2.0
I-AMI Data Element/Variable List

General Data Element Name
Admission Date
Birthdate
Discharge Date
Hospital Patient Identifier
ICD Other Diagnosis Code
ICD Principal Diagnosis Code
Sex
Data Element Name
ACEI Prescribed at Discharge
Adult Smoking Counseling
Adult Smoking History
ARB Prescribed at Discharge
Arrival Date
Aspirin Prescribed at Discharge
Aspirin Received Within 24 Hours Before or After
Hospital Arrival
Beta Blocker Prescribed at Discharge
Discharge Disposition
LVSD
Reason for No ACEI and No ARB at Discharge
Reason for No Aspirin at Discharge
Reason for No Aspirin on Arrival
Reason for No Beta Blocker at Discharge
Transfer From Another Hospital
Collected For:
All measures
All measures
All measures
All measures
All measures
All measures
All measures
Collected For:
I-AMI-3
I-AMI-4
I-AMI-4
I-AMI-3
I-AMI-1
I-AMI-2
I-AMI-1
I-AMI-5
I-AMI-1, I-AMI-2, I-AMI-3, I-AMI-4, I-AMI-5,
I-AMI-9
I-AMI-3
I-AMI-3
I-AMI-2
I-AMI-1
I-AMI-5
I-AMI-9

Version 2.0
I-AMI Initial Eligible Patient Population Criteria

The population of the I-AMI measure set is identified using 4 data elements/variables:
Admission Date
Birthdate
Discharge Date
Patients admitted to the hospital for inpatient acute care with an ICD Principal Diagnosis
Code or principal diagnosis of Acute Myocardial Infarction (AMI) as defined in Appendix
A, Table 1.1 AND a Patient Age (Admission Date minus Birthdate) greater than or equal
to 18 years of age are included in the I-AMI Initial Patient Population and are
eligible to be sampled.
For more information on sampling, go to Appendix I: Measure Sampling.

Version 2.0
I-AMI Initial Eligible Patient Population Word Algorithm

Variable Key:
Patient Age, and Initial Population Reject Case
1. Start AMI Initial Patient Population logic sub-routine. Process all quarterly discharge
inpatient cases (cases with discharge dates in the specific data collection time period)
that have successfully reached the point in the Data Processing Flow: Do not process
cases that have been rejected before this point in the Data Processing Flow.
2. Check ICD Principal Diagnosis Code
a. If the ICD Principal Diagnosis Code is not on Table 1.1, the patient is not in the AMI
Initial Patient Population and is not eligible to be sampled for the AMI measure set.
Set the Initial Patient Population to equal reject case. Return to Data Processing
Flow.
b. If the ICD Principal Diagnosis Code is on Table 1.1, continue processing and
proceed to Patient Age calculation.
3. Calculate Patient Age. Patient Age, in years, is equal to the Admission Date minus the
Birthdate. Use the month and day portion of Admission Date and Birthdate to yield the
most accurate age.
4. Check Patient Age
a. If the Patient Age is less than 18 years, the patient is not in the I-AMI Initial Patient
Population and is not eligible to be sampled for the I-AMI measure set. Set the Initial
Patient Population to equal reject case. Return to Data Processing Flow.
b. If the Patient Age is greater than or equal to 18 years, continue processing and
proceed to each measures Clinical Data Processing Flow.

Version 2.0
I-AMI-1: Aspirin on Arrival

Measure Overview
I-AMI-1 Aspirin received within 24 hours of arrival to the hospital for patients
having an Acute Myocardial Infarction.
Overview/Details:
Aspirin received within 24 hours of arrival to the hospital for patients having an Acute
Myocardial Infarction (AMI).
Rationale:
The early use of aspirin in patients with Acute Myocardial Infarction results in a
significant reduction in adverse events and subsequent mortality.
Measure-Related Outcomes
Mortality: Decreased mortality
Readmissions within 30 days: Decreased
Reliability: Increased delivery of evidence based care
Improvement noted as: Increase in rate
Patient Settings/Services:
Emergency Services/Department
Intensive Care Units
Medical/Surgical units
Indicator Name: Aspirin on arrival
Numerator: AMI patients who received aspirin within 24 hours before
or after hospital arrival
Denominator: AMI patients who are age >= 18 years

Version 2.0
Measure-Related
Domains of
Performance
Measure-Related
Measure- MeasureQuality Improvement and
Related
Topic
Patient Safety (QPS)
Clinical
Related
Standards
Care
I-Patient
QPS.3 through QPS.3.3 Intent Program
Safety
Statement Clinical Areas Certification Goals
Appropriateness
QPS.3.1
Availability
1. patient assessments
Continuity
5. antibiotic and other
Effectiveness
AMI
Goal 1
medication use
Timeliness

Version 2.0
I-AMI-1
Measure Details
Reasons and Implications: The benefits of aspirin therapy on mortality are
comparable to fibrinolytic therapy. The combination of aspirin and fibrinolytics provides
additive benefit for patients with ST-elevation myocardial infarction and aspirin is also
effective in patients with non-ST-elevation Myocardial Infarction. Clinical guidelines
strongly recommend aspirin for patients hospitalized with AMI.
Data Collection:
Retrospective data sources for the required data elements include administrative data
and medical records.
Numerator: AMI patients who received aspirin within 24 hours before or after hospital
arrival
Data Elements:
Aspirin Received Within 24 Hours Before or After Hospital Arrival
Inclusions to the numerator population: Not Applicable
Exclusions from the numerator population: None
Denominator: AMI patients who are >= 18 years
Data Elements:
Arrival Date
Birthdate
Discharge Disposition
Reason for No Aspirin on Arrival
Inclusions to the denominator population: Patients with ICD Principal Diagnosis
Code for AMI as defined in Appendix A, Table 1.1.
Exclusions from the denominator population:
Patients less than 18 years of age
Patients who left against medical advice
Patients who expired on day of or day after arrival
Version 2.0
Patients with a documented Reason for No Aspirin on Arrival

Patients discharged/transferred to another hospital for inpatient care

10
Version 2.0
I-AMI-1
References
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al.
ACC/AHA 2007 guidelines for the management of patients with unstable
angina/nonST-elevation myocardial infarction: a report of the American College
of Cardiology/American Heart Association Task Force on Practice Guidelines
(Writing Committee to Revise the 2002 Guidelines for the Management of Patients
With Unstable Angina/NonST-Elevation Myocardial Infarction): developed in
collaboration with the American College of Emergency Physicians, American
College of Physicians, Society for Academic Emergency Medicine, Society for
Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
J Am Coll Cardiol. 2007;50:e1157.
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al.
ACC/AHA guidelines for the management of patients with ST-elevation myocardial
infarction: a report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (Committee to Revise the 1999
Guidelines for the Management of Patients With Acute Myocardial Infarction).
2004.
Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et
al. ACC/AHA 2008 performance measures for adults with ST-elevation and non
ST-elevation myocardial infarction: a report of the American College of
Cardiology/American Heart Association Task Force on Performance Measures
(Writing Committee to Develop Performance Measures for ST-Elevation and Non
ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046 99.
Randomized trial of intravenous streptokinase, oral aspirin, both or neither among
17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second
International Study of Infarct Survival) Collaborative Group. Lancet. 1988 Aug
13;2(8607):349w-60.
Risk of myocardial infarction and death during treatment with low dose aspirin and
intravenous heparin in men with unstable coronary artery disease. The RISC
Group. Lancet. 1990;336(8719):827-830.
Theroux P, Ouimet H, McCans J et al. Aspirin, heparin, or both to treat acute
unstable angina. N Engl J Med. 1988;319(17):1105-1111.

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Version 2.0
I-AMI-1
Aspirin on Arrival
START
Run inpatient cases with ICD Principal

Diagnosis Code or principal diagnosis
of AMI, Appendix A, Table 1.1
ICD Principal
Diagnosis Code
for Acute Myocardial
Infarction(AMI)
NO
Case NOT in the I-AMI

Initial Population
< 18 years
Case NOT in the I-AMI

Initial Population
YES
Patient Age (in years) =

Admission Date Birthdate
Run case for patients = > 18 years old
Patient Age
= > 18years
Check what the earliest documented

date the patient arrived at the hospital
Arrival Date
UTD
Case Did Not Meet the

Measure and is in the
Measure
Population (D)
2, 3, or 4a
Case Not in Measure

Population-Excluded (B)
Valid Date
Check if patient expired on the day of

or day after arrival or signed out of the
hospital against medical advice (AMA)
or was transferred to another hospital
for inpatient care
Discharge
Disposition
1, 4b, 5, or 6
Check if aspirin was received within 24

hours before or after hospital arrival
Aspirin
Received Within 24
Hours Before or After
Hospital Arrival
YES
Case Met Measure and is in

the Numerator
Population (E)
YES
Case Not in Measure

Population-Excluded (B)
NO
Check if theres a documented reason

for no aspirin on arrival
Reason for
No Aspirin on
Arrival
NO
Case Did Not Meet the

Measure and is in the Measure
Population (D)
STOP

12
Version 2.0
I-AMI-1 Aspirin at Arrival

Word Algorithm
Numerator: Acute Myocardial Infarction (AMI) patients who received aspirin within 24 hours
before or after hospital arrival
Denominator: AMI patients
1. Start processing. Run cases that are included in the I-AMI Initial Patient Population
and pass the edits defined in the Data Processing Flow: Clinical data abstraction
through this measure.
2. Check Arrival Date
a. If Arrival Date equals Unable to Determine (UTD), the case will proceed to a
Measure Category Assignment of D and will be in the Measure Population.
Stop processing.
b. If Arrival Date equals a Non Unable to Determine value, continue processing and
proceed to the check Discharge Disposition.
3. Check Discharge Disposition.
a. If the Discharge Disposition equals 2, 3, or 4a, the case will proceed to a Measure
Category Assignment of B and will not be in the measure population. Stop
processing.
b. If the Discharge Status is equals 1, 4b, 5, or 6, continue processing and proceed to
Aspirin Received Within 24 Hours Before or After Hospital Arrival.
4. Check Aspirin Received Within 24 Hours Before or After Hospital Arrival
a. If Aspirin Received Within 24 Hours Before or After Hospital Arrival equals yes, the
case will proceed to a Measure Category Assignment of E and will be in the
Numerator Population. Stop processing.
b. If Aspirin Received Within 24 Hours Before or After Hospital Arrival equals No,
continue processing and proceed to check Reason for No Aspirin on Arrival.
5. Check Reason for No Aspirin on Arrival
a. If Reason for No Aspirin on Arrival equals Yes, the case will proceed to a Measure
Category Assignment of B and will not be in the Measure Population. Stop
processing.
b. If Reason for No Aspirin on Arrival equals No, the case will proceed to a Measure
Category Assignment of D and will be in the Measure Population. Stop
Processing
13
Version 2.0
Measure Calculation:
After the case data abstraction and data flow is completed, circle the assigned
Measure Category Assignment (MCA) Letter for each measure as guided by the
allowable answer value text:
I-AMI-1
B-Excluded
D-Not met
E-Met/Passed
measure*
measure**
When calculating measure rate for all abstracted cases in the discharge month:
Numerator cases = E
Denominator cases = D plus E
Divide the numerator counts by the denominator counts and X 100 = percentage
rate of measure compliance with recommended standard of care
Glossary Terms:
*Not Met Measure refers to a medical record which does not contain all of the criteria
required to be part of the measures numerator population.
**Met Measure refers to a medical record which contains all of the criteria required to
be part of the measures numerator population.

14

JCI I-AMI-1 ASA On Arrival Specifications SAMPLE 2012

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Version 2.

Use Ctrl + Home keys to go to the title page

Use Ctrl + Home keys to go to the title page

Joint Commission International Acute Myocardial Infarction (I-AMI)

Measure Short Name

Aspirin Prescribed at Discharge

ACEI or ARB for LVSD

Adult Smoking Cessation

Beta Blocker Prescribed at

Use Ctrl + Home keys to go to the title page

I-AMI Data Element/Variable List

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I-AMI Initial Eligible Patient Population Criteria

ICD Principal Diagnosis Code

For more information on sampling, go to Appendix I: Measure Sampling.

Use Ctrl + Home keys to go to the title page

I-AMI Initial Eligible Patient Population Word Algorithm

Patient Age, and Initial Population Reject Case

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I-AMI-1: Aspirin on Arrival

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5. antibiotic and other

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Patients with a documented Reason for No Aspirin on Arrival

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Run inpatient cases with ICD Principal

Case NOT in the I-AMI

Case NOT in the I-AMI

Patient Age (in years) =

Check what the earliest documented

Case Did Not Meet the

Case Not in Measure

Check if patient expired on the day of

Check if aspirin was received within 24

Case Met Measure and is in

Case Not in Measure

Check if theres a documented reason

Case Did Not Meet the

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I-AMI-1 Aspirin at Arrival

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