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PRIME Project 3.4 Resource Stewardship: Blood ProductsMetric Specification Manual V2.4

DHCS has approved this specifications manual and associated quality improvement benchmarks for the sole purpose of facilitating the participation of qualified entities in the PRIME program, pursuant

to the applicable Special Terms and Conditions of the Medi-Cal 2020 Demonstration.

Document Control LogVersion Date DetailsV2.3 6/30/16 Approved by DHCS

Added time criteria to PRIME Eligible Population incarceration exclusionAdded The Joint Commission link to the new ePBMs specificationsRemoved link to Metric Question Form

V2.4 8/31/16 Approved by DHCSRemoved PBMsAdded Local Mapping section at the beginningAdded specs for recently approved Joint Commission ePBMsDeleted note about CMS Core Measure Value Sets as it is not pertinentAdded Copyright Information

Measurement Periods

Demonstration Year Mid-Year Report Measurement Period Final Year-End Report Measurement PeriodDY 11 Not applicable Jul 1, 2015 – Jun 30, 2016DY12 Jan 1, 2016 – Dec 31, 2016 Jul 1, 2016 – Jun 30, 2017DY13 Jan 1, 2017 – Dec 31, 2017 Jul 1, 2017 – Jun 30, 2018DY14 Jan 1, 2018 – Dec 31, 2018 Jul 1, 2018 – Jun 30, 2019DY15 Jan 1, 2019 – Dec 31, 2019 Jul 1, 2019 – Jun 30, 2020

Local Mapping

For any metric, PRIME Entities may opt to use "local"/proprietary codes or values to the standard codes specified in PRIME Metric Spec Manual to determine numerator, denominator/exclusion values. PRIME Entities that do not use the specified coding system must "map" the codes they used to the codes specified in the manual.

Local workflows or local tracking may not substitute for codes and but the metric spec codes may be mapped on the backend – but only if the PRIME entity has some form of auditable process in place. To support this auditable process, it is recommended (although not required to be reported for PRIME) that PRIME entities have, at a minimum, documentation that includes a crosswalk containing the relevant codes, descriptions and clinical information. It is also recommended that PRIME entities document the policies and procedures they use to implement codes or values other than the specified coding systems.

Return to Summary Table of 33 v2.4 8/31/16


PRIME Eligible Population for Designated Public Hospitals (DPHs) only:

The PRIME Eligible Population includes the combination of both Population #1 and Population #2. An individual does not have to meet criteria of both Population #1 and Population #2. Any individual who meets either PRIME Eligible Population #1 criteria or PRIME Eligible Population #2 criteria must be included in the PRIME Eligible Population.

Population #1: Individuals of all ages with at least 2 encounters with the PRIME Entity Primary Care team during the measurement period.

A Primary Care team encounter is counted if occurred with a member of the Primary Care Team from Family Medicine, Internal Medicine, or Pediatrics. The PRIME Entity may choose to include populations who are seen for primary care in a specialty clinic (e.g. HIV)

Encounters include either a face-to-face visit with a primary care provider OR any encounter included in the list of eligible non-traditional service types described in the Global Payment Program1 (for PRIME, encounters not limited to uninsured individuals.)

Only encounters with the Primary Care team in the ambulatory setting will be counted toward the above 2 encounter requirement. Encounters with primary care team members in the inpatient setting do not count toward the two primary care encounter requirement. [This does not impact the expansion of the PRIME Eligible Population to include inpatient or acute care utilization as specified by the Project Target Population criteria e.g. in Domain 3].

Population #2Individuals of all ages who are in Medi-Cal Managed Care with 12 months of continuous assignment to the PRIME Entity during the Measurement Period.

No more than one gap in enrollment or assignment with the PRIME Entity of up to 45 days during the Measurement Period.

Individual must be enrolled in the primary plan and assigned to the PRIME Entity on the final day of the Measurement Period.

PRIME Eligible Population for District Municipal Hospitals (DMPHs) only:

The PRIME Eligible Population is all individuals with at least two encounters by the participating PRIME entity among Medi-Cal Beneficiaries.

1 Non-traditional service encounters as listed in California’s MediCal 2020 Special Terms and Conditions Attachment FF: Global Payment Program Valuation Protocol, Table 5: Categories of Service and Point Values, Non-Traditional


http://www.dhcs.ca.gov/provgovpart/Documents/Waiver%20Renewal/MC2020AttFF.pdf


Tenure Criteria for DPH/DMPH PRIME Eligible Population Encountered Lives1. The first of the two required primary care encounters (DPH) or Medi-Cal encounters (DMPH)

must occur during the first 6 months of the measurement period2. The second required (primary care) encounter may occur at any point during the measurement

period.3. The two (primary care) encounters during the measurement period fulfilling the PRIME Eligible

Population eligibility criteria cannot occur on the same day.

Exclusion Criteria for DPH/DMPH PRIME Eligible PopulationExclusion for patients no longer the responsibility of the PRIME Entity at the end of the measurement period:

1. Any patient meeting the PRIME Eligible Population Encountered Lives criteria in a given measurement period who then experiences any of the following scenarios, will be removed from the PRIME Eligible Population for that measurement period, when the PRIME entity has documentation that before the end of the measurement period:

a. The patient has died.b. The patient has changed their care to a PCP in a health system that is not the PRIME

Entity.c. The patient has had a total time of incarceration during the measurement period that

exceeded 45 days, regardless of the number of times the individual was incarcerated during the measurement period.

Project 3.4 Target Population are those in the

1) PRIME Eligible Population OR 2) Individuals with any acute care utilization (including Urgent Care, Emergency Department,

and Inpatient encounters) at the PRIME entity during the measurement period



Summary TableThis table does not contain all the criteria for the numerator and denominator. Adhere to the metric specification.

3.4.1 - ePBM-01 Pre-op Anemia Screening, Selected Elective Surgical PatientsSpecification Source: https://www.jointcommission.org/measure_development_initiatives.aspx3.4.2 - ePBM-02 Pre-op Hemoglobin Level, Selected Elective Surgical PatientsSpecification Source: https://www.jointcommission.org/measure_development_initiatives.aspx3.4.3 - ePBM-03 Pre-op Type and Crossmatch, Type and Screen, Selected elective Surgical PatientsSpecification Source: https://www.jointcommission.org/measure_development_initiatives.aspx3.4.4 - ePBM-04 Initial Transfusion ThresholdSpecification Source: https://www.jointcommission.org/measure_development_initiatives.aspx3.4.5 - ePBM-05 Outcome of Patient Blood Management, Selected Elective Surgical PatientsSpecification Source: https://www.jointcommission.org/measure_development_initiatives.aspx

The measures for this project will be the five electronic Patient Blood Management measures by The Joint Commission.

ePBM-01 Pre-op Anemia Screening, Selected Elective Surgical PatientsePBM-02 Pre-op Hemoglobin Level, Selected Elective Surgical PatientsePBM-03 Pre-op Type and Crossmatch, Type and Screen, Selected elective Surgical PatientsePBM-04 Initial Transfusion ThresholdePBM-05 Outcome of Patient Blood Management, Selected Elective Surgical Patients

The specifications can be found on The Joint Commission website:https://www.jointcommission.org/measure_development_initiatives.aspx Go to the box in the middle of the page and click on the Electronic Patient Blood Management Measures. Then click on each measure to open the individual zip files. Reproductions of the file specs are below for reference.



eMeasure Title

PBM-01: Preoperative Anemia Screening

eMeasure Identifier (Measure Authoring Tool)

503 eMeasure Version number

0.0.007

NQF Number N/A GUID ec46618c-7180-492b-b2bd-8ad863faecb1

Measurement Period

January 1, 20XX through December 31, 20XX

Measure Steward

Joint Commission

Measure Developer

Joint Commission

Endorsed By None

Description The proportion of selected elective surgical patients age 18 years and over with documentation of pre-operative anemia screening in the window between 45 and 14 days before the surgery start date.

VSAC Value Set Expansion Identifier

VSAC Auto Expansion

Copyright Measure specifications are in the Public Domain

LOINC(R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2016 International Health Terminology Standards Development Organization. All rights reserved.

Disclaimer These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.

Measure Scoring Proportion

Measure Type Process

Measure Item Count

Encounter, Performed: Encounter Inpatient

Stratification None

Risk Adjustment None



Rate Aggregation

None

Rationale Researchers have shown that preoperative hemoglobin (hgb.) and hematocrit can be used as predictors of outcome for specific types of patients such as cardiac artery bypass graft or orthopedic surgery. Preoperative anemia is associated with increased morbidity and mortality after surgery as well as exposure to allogeneic blood transfusions. Previously undiagnosed anemia was identified in 5% - 75% of elective surgery patient in certain populations and a national audit demonstrated that 35% of patients scheduled for joint replacement therapy have a hgb. < 13 g/dL on preadmission testing. In the elderly (>65 yr. old), the prevalence of anemia as defined by the World Health Organization (WHO) is 11% and 10.2% for men and women, respectively. Blood transfusions are associated with several postsurgical complications, including surgical site infections, pneumonia, slower wound healing, prolonged ventilator use and increased length of stay.Development of formal protocols for preoperative testing of hgb. for potential high blood loss elective surgeries could be used to identify and intervene for optimal management of blood resources. Early recognition of anemia offers patients an opportunity to receive the most appropriate transfusion-sparing strategy and avoid the risk of a potential transfusion. A panel of multidisciplinary physicians developed a clinical care pathway for anemia management in the elective surgical patients for whom blood transfusion is a probability (defined as any procedure for which a preoperative blood type and crossmatch is requested). They recommend that whenever clinically feasible, elective surgical patients should have a hgb. level tested a minimum of 30 days before the scheduled surgical procedure. Early detection, evaluation, and management of preoperative anemia (hgb. 12 g/dl for females and 13 g/dl for males) has been identified as an unmet medical need.

Clinical Recommendation Statement

Performance of screening for anemia well in advance of elective surgical procedures affords the opportunity to correct anemias in advance of the surgical procedure; these anemias, if undetected and uncorrected, could lead to unnecessary blood administration and an increased incidence of post-operative and transfusion-associated complications.

Improvement Notation

Improvement noted as an increase in rate.

Reference Bierbaum BE, Callaghan JJ, Galante JO, et al. An analysis of blood management in patients have a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999 Jan;81(1):2-10.

Reference Campbell DA, Henderson WG, Englesbe MJ, et al. Surgical site infection prevention: the importance of operative duration and blood transfusion--results of the first American College of Surgeons - National Surgical Quality Improvement Program Best Practices Initiative. J Am Coll Surg. 2008 Dec;207(6):810-20.

Reference Ferraris VA, Brown JR, Despotis GJ, Hammon JW, et al. 2011 Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation guidelines. Ann Thorac Surg 2011 Mar;91(3): 944-82.

Reference Goodnough LT, Maniatis A, Earnshaw P, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic patient: NATA guidelines. Br J Anaesth. 2011 Jan;106(1):13-22.

Reference Goodnough LT, Shander A, Spivak JL, et al. Detection, evaluation, and management of anemia in the elective surgical patient. Anesth Analg. 2005



Dec;101(6):1858-61.Reference Gruson KI, Aharonoff GB, Egol KA, et al. The relationship between admission

hemoglobin level and outcome after hip fracture. J Orthop Trauma. 2002 Jan;16(1):39-44.

Reference Guralnik JM, Eisenstaedt RS, Ferrucci L, et al. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004 Oct 15;104 (8):2263-8.

Reference Magovern JA, Sakert T, Magovern GJ, et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996 Nov 1;28(5):1147-53.

Reference Nissenson AR, Goodnough LT, Dubois RW. Anemia: not just an innocent bystander? Arch Intern Med. 2003 Jun 23;163(12):1400-4.

Reference Partridge J, Harari D, Gossage J, Dhesi J. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. J R Soc Med 2013: 106: 269-277.

Reference Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998 Feb;26(2):225-35.

Reference Roback JD, ed. Technical manual. 16th ed, Bethesda, Md.: AABB Press; 2008.

Reference Salido JA, Marin LA, Gomez LA, et al. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. JBone Joint Surg Am. 2002 Feb;84-A(2):216-20.

Reference Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010 Aug;113(2):482-95.

Reference Wilson A, Yu HT, Goodnough LT, et al. Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature. Am J Med. 2004 Apr 5;116 suppl 7A:50S-57S.

Definition None

Guidance The timeframe of <= 48 hour(s) is used in multiple instances and is intended to allow for inclusion of data recorded during a surgical procedure or related care that is related to the inpatient encounter but starts before the inpatient encounter is initiated.

Transmission Format

TBD

Initial Population Patients age 18 and older with a length of stay less than or equal to 120 days who undergo selected elective surgical procedures

Denominator Initial Population

Denominator Exclusions

* Patients with a solid organ transplant <=48 hours prior to the encounter or during the encounter* Patients with an encounter diagnosis of traumatic injury

Numerator Patients who had a laboratory test performed assessing hemoglobin level in the window between 45 and 14 days before the start of the elective surgical procedure

Numerator Not Applicable



Exclusions

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure, also identify payer, race, ethnicity and sex.

Table of Contents

Population Criteria Data Criteria (QDM Variables) Data Criteria (QDM Data Elements) Supplemental Data Elements Risk Adjustment Variables

Population Criteria

Initial Population = o AND: Occurrence A of $EncounterInpatient o AND: Age>= 18 year(s) at: Occurrence A of $EncounterInpatient o AND: "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

satisfies any: <= 48 hour(s) starts before or concurrent with start of Occurrence A of

$EncounterInpatient starts during Occurrence A of $EncounterInpatient

Denominator = o AND: Initial Population

Denominator Exclusions = o OR: "Procedure, Performed: Solid Organ Transplant" satisfies any:

<= 48 hour(s) starts before or concurrent with start of Occurrence A of $EncounterInpatient

starts during Occurrence A of $EncounterInpatient o OR: Intersection of:

Occurrence A of $EncounterInpatient "Encounter, Performed: Encounter Inpatient (diagnosis: Traumatic Injury)"

Numerator = o AND: "Laboratory Test, Performed: Hemoglobin blood serum plasma" satisfies all:

<= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

>= 14 day(s) starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

Numerator Exclusions = o None

Denominator Exceptions = o None

Stratification = o None

Data Criteria (QDM Variables)

$EncounterInpatient =



o "Encounter, Performed: Encounter Inpatient" satisfies all: (length of stay <= 120 day(s)) ends during "Measurement Period"

Data Criteria (QDM Data Elements)

"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient SNOMEDCT Value Set (2.16.840.1.113883.3.666.5.307)"

"Laboratory Test, Performed: Hemoglobin blood serum plasma" using "Hemoglobin blood serum plasma Grouping Value Set (2.16.840.1.113762.1.4.1104.4)"

"Procedure, Performed: Selected Elective Surgical Procedures" using "Selected Elective Surgical Procedures Grouping Value Set (2.16.840.1.113762.1.4.1029.19)"

"Procedure, Performed: Solid Organ Transplant" using "Solid Organ Transplant Grouping Value Set (2.16.840.1.113762.1.4.1029.11)"

Attribute: "Diagnosis: Traumatic Injury" using "Traumatic Injury Grouping Value Set (2.16.840.1.113762.1.4.1029.10)"


"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"

"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)" "Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)" "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex

AdministrativeGender Value Set (2.16.840.1.113762.1.4.1)"

Risk Adjustment Variables

None

Measure Set Patient Blood Management



eMeasure Title

PBM-02: Preoperative Hemoglobin Level



0.0.015

NQF Number None GUID ae481f21-58a8-4e9b-812a-8b5e0c2cf6e5

Measurement Period


Measure Steward

Joint Commission

Measure Developer

Joint Commission

Endorsed By None

Description Assessment of pre-operative hemoglobin levels of selected elective surgical patients age 18 and over who received a whole blood or packed red blood cell transfusion.







Measure Item Count


Stratification Report the following strata:Stratum 1-Patients whose most recent hemoglobin level measure prior to the surgical procedure was >= 12.0 gramsStratum 2-Patients whose most recent hemoglobin level measure prior to the surgical procedure was >= 11.0 grams and < 12.0 gramsStratum 3-Patients whose most recent hemoglobin level measure prior to the surgical procedure was >= 8.0 grams and < 11.0 grams



Stratum 4-Patients whose most recent hemoglobin level measure prior to the surgical procedure was < 8.0 grams


Rate Aggregation

None

Rationale There are many corrective interventions available for patients identified with sub-optimal hemoglobin levels preoperatively in order to avoid transfusion during or after the surgical procedure. As an essential component of blood management, pre-operative correction of anemia should be undertaken, since transfusion has been shown to increase adverse outcomes. Early detection, evaluation, and management of preoperative anemia has been identified as an unmet medical need (Spahn, 2010).

One study of hip and knee arthroplasty patients found that those with a hemoglobin level <13.0g/dL. had four times the risk for blood transfusion than those with higher hemoglobin levels (Salido, et al., 2002).

The World Health Organization (WHO) has defined the levels of anemia for men at a hemoglobin measurement of less than 13.0, and for non-pregnant women at a hemoglobin measurement of less than 12.0. There has, however, been controversy over these levels. While there is debate regarding the hemoglobin level at which patients are considered anemic (Beutler, 2006), use of the WHO definition of anemia allows identification of patients for whom pre-operative investigation of hemoglobin levels is warranted.


A restrictive blood administration approach, wherein transfusions are not administered unless the patients hemoglobin level is 7.0 or 8.0, provides life-saving treatment while effecting resource conservation and post-transfusion reduction of length of stay and reduced transfusion-associated complications.


A reduction should occur in the proportion of transfusions given to patients whose pre-operative hemoglobin levels were not in a range suggesting anemia.

Reference Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood Mar 1 2006 (107)5: 1747-1750.

Reference Campbell DA, Henderson WG, Englesbe MJ, et al. Surgical site infection prevention: the importance of operative duration and blood transfusion--results of the first American College of Surgeons - National Surgical Quality Improvement Program Best Practices Initiative. J Am Coll Surg. 2008 Dec;207(6):810-20.

Reference Goodnough LT, Maniatis A, Earnshaw P, et al. Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic patient: NATA guidelines. Br J Anaesth. 2011 Jan;106(1):13-22.

Reference Goodnough LT, Shander A, Spivak JL, et al. Detection, evaluation, and management of anemia in the elective surgical patient. Anesth Analg. 2005 Dec;101(6):1858-61.

Reference Gruson KI, Aharonoff GB, Egol KA, et al. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma. 2002 Jan;16(1):39-44.

Reference Guralnik JM, Eisenstaedt RS, Ferrucci L, et al. Prevalence of anemia in



persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood. 2004 Oct 15;104 (8):2263-8.

Reference Magovern JA, Sakert T, Magovern GJ, et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996 Nov 1;28(5):1147-53.

Reference Nissenson AR, Goodnough LT, Dubois RW. Anemia: not just an innocent bystander? Arch Intern Med. 2003 Jun 23;163(12):1400-4.

Reference Nutritional Anaemias. Report of a WHO Scientific Group. WHO Tech Rep Ser. 1968;405:1-401

Reference Reference Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998 Feb;26(2):225-35.


Reference Salido JA, Marin LA, Gomez LA, et al. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am. 2002 Feb;84-A(2):216-20.

Reference Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010 Aug;113(2):482-95.

Definition None

Guidance The denominator logic looks for all transfusions that start <=5 days after the start of the elective surgical procedure, including transfusions administered during surgery.

The timeframe of <= 48 hour(s) is used in multiple instances and is intended to allow for inclusion of data recorded during a surgical procedure or related care that is related to the inpatient encounter but starts before the inpatient encounter is initiated.

Transmission Format

TBD


Denominator Patients who had a whole blood or packed red blood cell transfusion administered in the time window from anytime during the surgical procedure to 5 days after the surgical procedure or to discharge, whichever is sooner.


* Patients with a solid organ transplant <=48 hours prior to or during the encounter.* Patients with an encounter diagnosis of traumatic injury* Patients with an encounter diagnosis of sickle cell disease and related red blood cell disorders* Patients with an encounter diagnosis of pregnancy* Patients with a maternal or fetal procedure <=48 hours prior to or during the encounter.* Patients who undergo extra-corporeal membrane oxygenation (ECMO) procedures prior to the elective surgical procedure

Numerator Patients who had laboratory test performed assessing hemoglobin level <= 45 days before the start of the elective surgical procedure.

Numerator Not Applicable



Exclusions


None



Table of Contents


Population Criteria




Denominator = o AND: Initial Populationo AND: "Procedure, Performed: Blood Transfusion Administration" satisfies all:

<= 5 day(s) starts after start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

starts before end of Occurrence A of $EncounterInpatient Denominator Exclusions =

o OR: "Procedure, Performed: Solid Organ Transplant" satisfies any: <= 48 hour(s) starts before or concurrent with start of Occurrence A of


o OR: Intersection of: Occurrence A of $EncounterInpatient "Encounter, Performed: Encounter Inpatient" satisfies any:

(diagnosis: Traumatic Injury) (diagnosis: Sickle Cell Disease and Related Blood Disorders) (diagnosis: Pregnancy, Childbirth, and the Puerperium)

o OR: "Procedure, Performed: Maternal and Fetal Procedures" satisfies any: <= 48 hour(s) starts before or concurrent with start of Occurrence A of


o OR: "Procedure, Performed: ECMO" starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

Numerator = o AND: Most Recent: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum

plasma" <= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"





Stratifications = o Stratification 1 =

AND: Most Recent: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma" <= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

AND: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma (result >= 12.0 g)"

o Stratification 2 = AND: Most Recent: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood

serum plasma" <= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

AND: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma" satisfies all:

(result >= 11.0 g) (result < 12.0 g)




(result >= 8.0 g) (result < 11.0 g)



AND: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma (result < 8.0 g)"


$EncounterInpatient = o "Encounter, Performed: Encounter Inpatient" satisfies all:

(length of stay <= 120 day(s)) ends during "Measurement Period"




"Procedure, Performed: Blood Transfusion Administration" using "Blood Transfusion Administration SNOMEDCT Value Set (2.16.840.1.113762.1.4.1029.24)"

"Procedure, Performed: ECMO" using "ECMO Grouping Value Set (2.16.840.1.113762.1.4.1029.22)" "Procedure, Performed: Maternal and Fetal Procedures" using "Maternal and Fetal Procedures

Grouping Value Set (2.16.840.1.113762.1.4.1029.51)" "Procedure, Performed: Selected Elective Surgical Procedures" using "Selected Elective Surgical

Procedures Grouping Value Set (2.16.840.1.113762.1.4.1029.19)" "Procedure, Performed: Solid Organ Transplant" using "Solid Organ Transplant Grouping Value Set

(2.16.840.1.113762.1.4.1029.11)" Attribute: "Diagnosis: Traumatic Injury" using "Traumatic Injury Grouping Value Set

(2.16.840.1.113762.1.4.1029.10)"



Attribute: "Diagnosis: Pregnancy, Childbirth, and the Puerperium" using "Pregnancy, Childbirth, and the Puerperium Grouping Value Set (2.16.840.1.113762.1.4.1029.50)"

Attribute: "Diagnosis: Sickle Cell Disease and Related Blood Disorders" using "Sickle Cell Disease and Related Blood Disorders Grouping Value Set (2.16.840.1.113762.1.4.1029.35)"






None




eMeasure Title

PBM-03: Preoperative Blood Type Testing and Antibody Screening



0.0.005

NQF Number N/A GUID 60f18ed7-20de-4ebc-9732-b07942cec95d

Measurement Period


Measure Steward

Joint Commission

Measure Developer

Joint Commission

Endorsed By None

Description The proportion of selected elective surgical patients age 18 and over who received timely performance of a pre-operative type and crossmatch or type and screen

Copyright Measure specifications are in the Public Domain LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2016 International Health Terminology Standards Development Organization. All rights reserved.




Measure Item Count


Stratification None


Rate Aggregation

None



Rationale Beginning an elective surgery that is considered a high-blood loss procedure without confirming the availability of a patients specific blood type should be an important patient safety concern for all hospitals and patients. Hospitals need to ensure that sufficient compatible blood is available for each scheduled procedure since about 3% of specimens have a serologic finding that requires further investigation that may cause a delay in the availability of the blood. Now that many patients do not have blood testing until the day of the procedure, the results may not be completed by the time surgery begins. Studies related to the timely completion of type and screen (T&S) and verification of ABO/Rh status for elective surgery patients were minimal, but one recent study showed that 21 (7%) of the 309 patients scheduled for elective surgery, did not have the T&S sample tested before surgery. In another study, type and screen collected less than 3 days prior to surgery resulted in special efforts to find blood more than 1% of the time; type and screen collected on the same day as surgery resulted in a surgery delay almost 1% of the time (Friedberg, 2003).According to the 2011 Joint Commissions National Patient Safety Goal UP.01.01.01., a pre-procedure verification process should be conducted to identify items that must be available for the procedure using a standardized list that includes documentation of any required blood products for the procedure. Development of formal protocols to ensure that patients have blood testing completed (when ordered) prior to anesthesia start time for potential high-blood loss elective surgeries may optimize management of blood resources and maximize patient safety.


It is well-established that transfusion of blood that is not cross-matched carries with it the risk of hemolytic transfusion reaction and attendant morbidity and mortality. Collection of blood for antibody screening and/or cross-matching assures availability of a safer blood product should a transfusion need to occur.


Improvement noted as an increase in rate

Reference Chiganti S, Regan F. Are changes in admission practices for elective surgery posing a transfusion threat to patients? Transfus Med. 2002 Dec;12(6):353-6.

Reference Friedberg RC, Jones BA, Walsh MK. Type and screen completion for scheduled surgical procedures. A College of American Pathologists Q-Probes study of 8941 type and screen tests in 108 institutions. Arch Pathol Lab Med. 2003 May;127(5):533-40.

Reference Goodnough LT, Viele M, Fontaine M, et al. Quality management in the transfusion service: case studies in process improvement. Transfusion. 2011 Mar;51(3):600-9.

Reference Magovern JA, Sakert T, Magovern GJ, et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996 Nov;28(5):1147-53.

Reference Moore SB, Reisner RK, Losasso TJ, et al. Morning admission to the hospital for surgery the same day. A practical problem for the blood bank. Transfusion. 1987 Jul-Aug;27(4):359-61.


Reference Saxena S, Nelson JM, Osby M, et al. Ensuring timely completion of type and screen testing and the verification of ABO/Rh status for elective surgical patients. Arch Pathol Lab Med. 2007 Apr;131(4):576-81.

Reference Weinstein R. Quick Reference 2012 Clinical Practice Guide on Red Blood



Cell Transfusion. Presented by the American Society of Hematology. Adapted from A Clinical Practice Guideline from the AABB. Ann Int Med, 2012;157:49-58.

Definition None

Guidance The timeframe of <= 48 hour(s) is used in multiple instances and is intended to allow for inclusion of data recorded during a surgical procedure or related care that is related to the inpatient encounter but starts before the inpatient encounter is initiated. The lab tests Type and Crossmatch and Type and Screen are lab panels with component results. In LOINC, each component is represented with a unique code. In the measure logic, the concepts of Type and Crossmatch and Type and Screen are represented with a variable, $ScreenorCrossmatch. This variable includes the component codes for Blood Group Antibody Screen and Major Crossmatch. If either code is present, it is assumed the patient had the panel procedure performed. While blood administration is not evaluated in this measure, patients who refuse blood product administration are excluded. The data elements required for this exclusion are further defined in the Data Criteria (QDM Data Elements) section of the measure.

Transmission Format

TBD

Initial Population

Patients age 18 and older with a length of stay less than or equal to 120 days who undergo selected elective surgical procedures

Denominator Initial Population


* Patients with a solid organ transplant <=48 hours prior to the encounter or during the encounter* Patients with an encounter diagnosis of traumatic injury* Patients who refuse transfusion within 45 days prior to the start of the elective surgical procedure or during the encounter

Numerator Patients who had a type and screen or type and crossmatch completed within 45 days prior to the start of the elective surgical procedure.

Numerator Exclusions

Not Applicable


None



Table of Contents




Population Criteria

Initial Population = o AND: Occurrence A of $EncounterInpatient o AND: Age>= 18 year(s) at: Occurrence A of $EncounterInpatient o AND: "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures PBM03"



Denominator = o AND: Initial Population




Occurrence A of $EncounterInpatient "Encounter, Performed: Encounter Inpatient (diagnosis: Traumatic Injury)"

o OR: Union of: "Procedure, Order not done: Patient Refusal" for "Blood Transfusion Administration"

<= 45 day(s) starts before or concurrent with end of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures PBM03"

"Procedure, Order not done: Patient Refusal" for "Blood Transfusion Administration" starts during Occurrence A of $EncounterInpatient

Numerator = o AND: $ScreenorCrossmatch <= 45 day(s) starts before start of "Occurrence A of Procedure,

Performed: Selected Elective Surgical Procedures PBM03" Numerator Exclusions =

o None Denominator Exceptions =

o None Stratification =

o None


$ScreenorCrossmatch = o Union of:

"Laboratory Test, Performed: Blood Group Antibody Screen" "Laboratory Test, Performed: Major Crossmatch"





"Laboratory Test, Performed: Blood Group Antibody Screen" using "Blood Group Antibody Screen LOINC Value Set (2.16.840.1.113762.1.4.1029.30)"

"Laboratory Test, Performed: Major Crossmatch" using "Major Crossmatch LOINC Value Set (2.16.840.1.113762.1.4.1029.29)"

"Procedure, Order: Blood Transfusion Administration" using "Blood Transfusion Administration SNOMEDCT Value Set (2.16.840.1.113762.1.4.1029.24)"



"Procedure, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"

"Procedure, Performed: Selected Elective Surgical Procedures PBM03" using "Selected Elective Surgical Procedures PBM03 Grouping Value Set (2.16.840.1.113762.1.4.1029.14)"








None




eMeasure Title

PBM-04: Initial Transfusion Threshold



0.0.007

NQF Number None GUID a4980ce9-29fa-4951-ac1d-fa251d284e01

Measurement Period


Measure Steward

Joint Commission

Measure Developer

Joint Commission

Endorsed By None

Description The proportion of various pre-transfusion hemoglobin levels in patients age 18 and over receiving the first unit of a whole blood or packed cell transfusion.







Measure Item Count


Stratification Report the following strata:Stratum 1-Patients whose most recent hemoglobin level <=45 day(s) prior to the first transfusion was <7.0 gramsStratum 2-Patients whose most recent hemoglobin level <=45 day(s)prior to the first transfusion was between >=7.0 grams and <8.0 gramsStratum 3-Patients whose most recent hemoglobin level <=45 day(s)prior to the first transfusion was between >=8.0 grams and <9.0 grams



Stratum 4-Patients whose most recent hemoglobin level <=45 day(s)prior to the first transfusion was between >=9.0 grams and <10.0 gramsStratum 5-Patients whose most recent hemoglobin level <=45 day(s) prior to the first transfusion >=10.0 grams


Rate Aggregation

None

Rationale All published sources indicate that a strict transfusion strategy is preferable to a liberal strategy, since transfusion can be harmful and contributes to higher mortality, infection, and other complications (Carson, Grossman 2012, Goodnough 2012, Paone 2014, Shander 2014). Most guidelines recommend a threshold of 7.0 or 8.0 grams of hemoglobin or less as an indication for transfusion, and if the hemoglobin level is 10.0 or greater there is agreement that the transfusion is rarely indicated. There is disagreement among guidelines, however, when patients have underlying cardiac disease, postoperative status, or other clinical conditions (Shander, 2013, and others), and there is some concern about a lack of robust evidence to support some guidelines (Carson, [Cochrane] 2012, Wilkinson, 2011). Caution is always advised that when determining the appropriateness of transfusion, underlying clinical conditions and symptoms should be taken into consideration.

The purpose of this measure is to allow facilities to profile blood usage according to initial transfusion hemoglobin thresholds. Strata are defined to direct facility review to the appropriateness of selected transfusions, taking into account clinical symptoms combined with hemoglobin measurements. By this review, facilities will be able to determine the best approaches to enhance blood conservation and management and over time. There should be a gradual decline in the proportion of initial units given from the higher hemoglobin values to those lower values supported in the literature and guidelines as part of a blood management program.


A restrictive blood administration approach, wherein transfusions are not administered unless the patients hemoglobin level is 7.0 or 8.0, provides life-saving treatment while effecting resource conservation and post-transfusion reduction of length of stay and reduced transfusion-associated complications.


Over time, a shift in the proportion of initial units given in the higher hemoglobin values to units given in the lower hemoglobin values.

Reference American Red Cross. A Compendium of Transfusion Practice Guidelines. Second Edition 2013.

Reference Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion (Review). The Cochrane Library 2012.

Reference Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, et al. Red Blood Cell Transfusion: A Clinical Practice Guideline from the AABB. Ann Int Med 2012; 157: 49 - 58.




Reference Goodnough LT, Shander A. Patient Blood Management. Anesthesiology v116; No 6, June 2012

Reference Napolitano LM, Kurek S, Luchette FA, Corwin HL, et al. Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care. Crit Care Med 2009 Vol 37, No 12

Reference New York State Council on Human Blood and Transfusion Services, New York State Department of Health. Guidelines For Transfusion of Red Blood Cells - Adults. Third Edition, 2012.

Reference Paone G, Likosky DS, Brewer R, Theurer PF, et al. Transfusion of 1 and 2 Units of Red Blood Cells is Associated With Increased Morbidity and Mortality. Ann Thorac Surg 2014; 97:87-94.

Reference Salpeter SR, Buckley JS, Chatterjee S. Impact of More Restrictive Blood Transfusion Strategies on Clinical Outcomes: A Meta-analysis and Systematic Review. The American Journal of Medicine, Article in Press.

Reference Shander A, Fink A, Javidroozi M, Erhard J, et al. Appropriateness of Allogeneic Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes. Transfusion Medicine Reviews, Vol. 25, No. 3 (July), 2011: pp 232-246.e53.

Reference Shander A, Goodnough LT. Can Blood Transfusion Be Not Only Ineffective, But Also Injurious? Ann Thorac Surg 2014; 97: 11-4.

Reference Shander A, Gross I, Hill S, Javidroozi M, Sledge S. A new perspective on best transfusion practices. Blood Transfus 2013; 11: 193-202.

Reference Spahn DR. Anemia and Patient Blood Management in Hip and Knee Surgery; A Systematic Review of the Literature. Anesthesiology, V 113, No. 2, August 2010.

Reference Wilkinson KL, Brunskill SJ, Doree C, Hopewell S, et al.The Clinical Effects of Red Blood Cell Transfusions: An Overview of the Randomized Controlled Trials evidence Base. Transfusion Medicine reviews, Vol 25, No.2 (April), 2011, pp 145-155 e2.

Definition None

Guidance The measure excludes patients who receive the first transfusion in the ED implicitly as the ED location is not included.

The numerator and strata look for a hemoglobin test performed <=45 days prior to the first blood transfusion. This timeframe was selected to include elective surgical patients who have hemoglobin level assessed preoperatively

The timeframe of <= 48 hour(s) is intended to allow for inclusion of data recorded during a surgical procedure that is related to the inpatient encounter but starts before the inpatient encounter is initiated.

Transmission Format

TBD

Initial Population

Patients age 18 and older with a length of stay less than or equal to 120 days who are discharged from inpatient care during the measurement period.

Denominator Patients receiving a unit of a whole blood or packed cell components that is transfused during an inpatient encounter


* Patients with a solid organ transplant <=48 hours prior to or during the encounter.



* Patients with an encounter diagnosis of traumatic injury.* Patients with an encounter diagnosis of sickle cell disease and related blood disorders.* Patients who undergo extra-corporeal membrane oxygenation (ECMO) procedure during the inpatient encounter.

Numerator Patients who had a laboratory test performed assessing hemoglobin level <= 45 days before the start of the first blood transfusion.

Numerator Exclusions

None


None



Table of Contents


Population Criteria

Initial Population = o AND: Occurrence A of $EncounterInpatient o AND: Age>= 18 year(s) at: Occurrence A of $EncounterInpatient

Denominator = o AND: Initial Populationo AND: "Occurrence A of Procedure, Performed: Blood Transfusion Administration" starts

during Occurrence A of $EncounterInpatient Denominator Exclusions =

o OR: "Procedure, Performed: Solid Organ Transplant" satisfies any: <= 48 hour(s) starts before or concurrent with start of Occurrence A of


o OR: Intersection of: Occurrence A of $EncounterInpatient "Encounter, Performed: Encounter Inpatient" satisfies any:

(diagnosis: Traumatic Injury) (diagnosis: Sickle Cell Disease and Related Blood Disorders)

o OR: "Procedure, Performed: ECMO" starts during Occurrence A of $EncounterInpatient Numerator =

o AND: First: "Occurrence A of Procedure, Performed: Blood Transfusion Administration" starts during Occurrence A of $EncounterInpatient

o AND: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma" <= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Blood Transfusion Administration"





Stratifications = o Stratification 1 =

AND: Most Recent: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma" <= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Blood Transfusion Administration"

AND: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma (result < 7.0 g)"


serum plasma" <= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Blood Transfusion Administration"













AND: "Occurrence A of Laboratory Test, Performed: Hemoglobin blood serum plasma (result >= 10.0 g)"








"Procedure, Performed: ECMO" using "ECMO Grouping Value Set (2.16.840.1.113762.1.4.1029.22)" "Procedure, Performed: Solid Organ Transplant" using "Solid Organ Transplant Grouping Value Set

(2.16.840.1.113762.1.4.1029.11)"










None




eMeasure Title

PBM-05: Blood Usage in Selected Elective Surgical Patients



0.0.006

NQF Number None GUID 18335cae-f69f-41bf-a181-ce9066fd4949

Measurement Period


Measure Steward

Joint Commission

Measure Developer

Joint Commission

Endorsed By None

Description The proportion of elective surgical patients age 18 years and older who had a preoperative anemia screening who received a surgically-related non-autologous red blood cell transfusion.

Copyright Measure specifications are in the Public Domain LOINC(R) is a registered trademark of the Regenstrief Institute. This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2016 International Health Terminology Standards Development Organization. All rights reserved.



Measure Type Outcome

Measure Item Count


Stratification None


Rate Aggregation

None

Rationale The goal of a patient blood management initiative for elective surgical patients that incorporates pre-operative screening and anemia correction, a restrictive



transfusion threshold, and other intra-operative or post-operative blood conservation measures is a reduction in the proportion of elective surgical patients receiving allogeneic or directed donation red blood cell transfusion.


Reducing the use of allogeneic blood by timely detection and correction of anemia and other conservation methods can conserve resources and reduce the incidence of transfusion-associated complications.


A lower score indicates better performance

Reference American Red Cross. A Compendium of Transfusion Practice Guidelines. Second Edition 2013.

Reference Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion (Review). The Cochrane Library 2012.

Reference Chiganti S, Regan F. Are changes in admission practices for elective surgery posing a transfusion threat to patients? Transfus Med. 2002 Dec;12(6):353-6.


Reference Friedberg RC, Jones BA, Walsh MK. Type and screen completion for scheduled surgical procedures. A College of American Pathologists Q-Probes study of 8941 type and screen tests in 108 institutions. Arch Pathol Lab Med. 2003 May;127(5):533-40.

Reference Goodnough LT, Shander A. Patient Blood Management. Anesthesiology v116; No 6, June 2012.

Reference Goodnough LT, Viele M, Fontaine M, et al. Quality management in the transfusion service: case studies in process improvement. Transfusion. 2011 Mar;51(3):600-9.

Reference Moore SB, Reisner RK, Losasso TJ, et al. Morning admission to the hospital for surgery the same day. A practical problem for the blood bank. Transfusion. 1987 Jul-Aug;27(4):359-61.

Reference Napolitano LM, Kurek S, Luchette FA, Corwin HL, et al. Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care. Crit Care Med 2009 Vol 37, No 12

Reference New York State Council on Human Blood and Transfusion Services, New York State Department of Health. Guidelines For Transfusion of Red Blood Cells - Adults. Third Edition, 2012.

Reference Paone G, Likosky DS, Brewer R, Theurer PF, et al. Transfusion of 1 and 2 Units of Red Blood Cells is Associated With Increased Morbidity and Mortality. Ann Thorac Surg 2014; 97:87-94.


Reference Salpeter SR, Buckley JS, Chatterjee S. Impact of More Restrictive Blood Transfusion Strategies on Clinical Outcomes: A Meta-analysis and Systematic Review. The American Journal of Medicine, Article in Press.

Reference Saxena S, Nelson JM, Osby M, et al. Ensuring timely completion of type and screen testing and the verification of ABO/Rh status for elective surgical patients. Arch Pathol Lab Med. 2007 Apr;131(4):576-81.

Reference Shander A, Fink A, Javidroozi M, Erhard J, et al. Appropriateness of Allogeneic



Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes. Transfusion Medicine Reviews, Vol. 25, No. 3 (July), 2011: pp 232-246.e53.

Reference Shander A, Goodnough LT. Can Blood Transfusion Be Not Only Ineffective, But Also Injurious? Ann Thorac Surg 2014;97: 11-4.

Reference Shander A, Gross I, Hill S, Javidroozi M, Sledge S. A new perspective on best transfusion practices. Blood Transfus 2013; 11: 193-202.

Reference Spahn DR. Anemia and Patient Blood Management in Hip and Knee Surgery; A Systematic Review of the Literature. Anesthesiology, V 113, No. 2, August 2010.

Reference Weinstein R. Quick Reference 2012 Clinical Practice Guide on Red Blood Cell Transfusion. Presented by the American Society of Hematology. Adapted from A Clinical Practice Guideline from the AABB. Ann Int Med, 2012;157:49-58.

Reference Wilkinson KL, Brunskill SJ, Doree C, Hopewell S, et al.The Clinical Effects of Red Blood Cell Transfusions: An Overview of the Randomized Controlled Trials evidence Base. Transfusion Medicine reviews, Vol 25, No.2 (April), 2011, pp 145-155 e2.

Definition None

Guidance The timeframe of <= 48 hour(s) is used in multiple instances and is intended to allow for inclusion of data recorded during a surgical procedure or related care that is related to the inpatient encounter but starts before the inpatient encounter is initiated.

Feasibility testing of the measure identified limited availability of data for the concept of allogeneic transfusions. Two data elements were found to be feasible and are used to represent patients who receive autologous rather than allogeneic transfusions. * In the numerator, any whole blood and packed cell blood administration event is represented with Procedure, Performed: Blood Transfusion Administration * In denominator exclusions, Autologous blood products are represented with Substance, Order: Autologous Blood Product * The intent is to capture all patients who undergo blood transfusion, excluding those who have documentation of an autologous blood product

Transmission Format

TBD


Denominator Patients who had a laboratory test performed assessing hemoglobin level in the window between 45 and 14 days before the start of the elective surgical procedure


* Patients with a solid organ transplant <= 48 hours prior to or during the encounter* Patients with an encounter diagnosis of traumatic injury* Patients with an encounter diagnosis of sickle cell disease and related blood disorders* Patients with an order for an autologous blood products* Patients who refuse blood transfusion at any time between 45 days prior to surgery to 5 days after the surgical procedure or to discharge, whichever is sooner

Numerator Patients who had a whole blood or packed red blood cell transfusion administered in the time window from anytime during the surgical procedure



to 5 days after the surgical procedure or to discharge, whichever is sooner.Numerator Exclusions

Not Applicable


None



Table of Contents


Population Criteria




Denominator = o AND: Initial Populationo AND: "Laboratory Test, Performed: Hemoglobin blood serum plasma" satisfies all:

<= 45 day(s) starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

>= 14 day(s) starts before start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"




Occurrence A of $EncounterInpatient "Encounter, Performed: Encounter Inpatient" satisfies any:

(diagnosis: Traumatic Injury) (diagnosis: Sickle Cell Disease and Related Blood Disorders)

o OR: "Substance, Order: Autologous Blood Product" starts during Occurrence A of $EncounterInpatient

o OR: Union of: "Procedure, Order not done: Patient Refusal" for "Blood Transfusion Administration"

<= 45 day(s) starts before or concurrent with end of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

"Procedure, Order not done: Patient Refusal" for "Blood Transfusion Administration" starts before end of Occurrence A of $EncounterInpatient



Numerator = o AND: "Procedure, Performed: Blood Transfusion Administration" satisfies all:

<= 5 day(s) starts after start of "Occurrence A of Procedure, Performed: Selected Elective Surgical Procedures"

starts before end of Occurrence A of $EncounterInpatient Numerator Exclusions =

o None Denominator Exceptions =

o None Stratification =

o None







"Procedure, Order: Blood Transfusion Administration" using "Blood Transfusion Administration SNOMEDCT Value Set (2.16.840.1.113762.1.4.1029.24)"

"Procedure, Order not done: Patient Refusal" using "Patient Refusal SNOMEDCT Value Set (2.16.840.1.113883.3.117.1.7.1.93)"


"Procedure, Performed: Selected Elective Surgical Procedures" using "Selected Elective Surgical Procedures Grouping Value Set (2.16.840.1.113762.1.4.1029.19)"


"Substance, Order: Autologous Blood Product" using "Autologous Blood Product SNOMEDCT Value Set (2.16.840.1.113762.1.4.1029.36)"








None



Copyright Information

These performance measures, specifications, and guidance for evaluating performance were developed and are owned by the National Committee for Quality Assurance (NCQA). These materials are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties or endorsement about the quality of any organization or physician that uses or reports these materials and NCQA has no liability to anyone who relies on the materials.

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The American Medical Association holds a copyright to the CPT® codes contained in the measures specifications.

The American Hospital Association holds a copyright to the Uniform Bill Codes (“UB”) contained in the measure specifications. The UB Codes in the HEDIS specifications are included with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS measure results or using HEDIS measure results for their internal quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Anyone desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact [email protected].
