SOMC Quality Dashboard: Fiscal Year 2011

Aspirin at Arrival for AMI

Acute Myocardial Infarction (AMI) patients without contraindications who received aspirin within 24 hours before or after hospital arrival.

Why is this important?

Aspirin has an antiplatelet activity which can prevent decreased blood flow.

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Aspirin at Discharge for AMI

Acute Myocardial Infarction (AMI) patients without aspirin contraindications who are prescribed aspirin at hospital discharge.

Why is this important?

Aspirin has an antiplatelet activity which can prevent decreased blood flow.

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Beta Blocker on Arrival for AMI

Acute Myocardial Infarction (AMI) patients without beta blocker contraindications who received a beta blocker within 24 hours after hospital arrival.

Why is this important?

Lowers blood pressure and can reduce the size of the infarction.

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Beta Blocker on Discharge for AMI

Acute Myocardial Infarction (AMI) patients without beta blocker contraindications prescribed a beta blocker at discharge.

Why is this important?

Lowers blood pressure and reduces death rates.

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ACE Inhibitor/ARB for LVSD for AMI

Acute Myocardial Infarction (AMI) patients with left ventricular systolic dysfunction (LVSD) and without ACEI/ARB contraindications who are prescribed an ACEI/ARB at discharge. LVSD is defined as a left ventricular ejection fraction less than 40 percent or a narrative description of left ventricular function consistent with moderate or severe systolic dysfunction.

Why is this important?

Lowers blood pressure and reduces the heart’s workload.

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Smoking Cessation Advice for AMI

Acute Myocardial Infarction (AMI) patients with a history of smoking cigarettes within the past 12 months, who are given smoking cessation advice or counseling during hospital stay.

Why is this important?

Smoking increases blood pressure, constricts heart vessels and reduces the effects of Beta Blockers.

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Perfect Care for AMI Patients

Acute myocardial infraction (AMI) patients that meet all the indicators:

• Aspirin on Arrival for AMI
• Aspirin at Discharge for AMI
• Beta Blocker on Arrival AMI
• Beta Blocker at Discharge for AMI
• ACEI/ARB for LVSD for AMI
• Smoking Cessation Advice for AMI Patients

Why is this important?

Patients receiving perfect care will achieve the optimal outcome.

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ACE Inhibitor/ARB at Discharge for CHF

CHF patients with left ventricular systolic dysfunction and without ACEI/ARB contraindications who are prescribed an ACEI/ARB at hospital discharge. LVSD is defined as a left ventricular ejection fraction less than 40 percent or a narrative description of left ventricular function consistent with moderate or severe systolic dysfunction.

Why is this important?

ACEI/ARB’s are now considered first-choice treatment and are the cornerstone of CHF drug therapy.

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LV Function Assessment for CHF

CHF patients with documentation that left ventricular function (LVF) was assessed before arrival, during hospitalization, or is planned for after discharge.

Why is this important?

Results from measuring LVF determines the optimal treatment options.

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Smoking Cessation Advice for CHF

CHF patients with a history of smoking cigarettes within the past 12 months, who are given smoking cessation advice or counseling during hospital stay.

Why is this important?

Smoking increases blood pressure, constricts heart vessels and is the leading preventable cause of death in the US.

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Discharge Instructions for CHF

CHF patients discharged home with written instructions or educational material given at discharge or during the hospital stay addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, what to do if symptoms worsen.

Why is this important?

Following discharge instructions can alleviate symptoms, slow the diseases progression and improve everyday life.

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Perfect Care for CHF Patients

CHF patients that meet all the indicators:

• ACE Inhibitor/ARB at Discharge for CHF
• LV Function Assessment for CHF Patients
• Smoking Cessation Advice for CHF Patients
• Discharge Instructions for CHF Patients

Why is this important?

Patients receiving perfect care will achieve the optimal outcome.

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Blood Culture Before Antibiotic for CAP

Collection of blood culture prior to first dose of antibiotic for community acquired pneumonia (CAP) patients.

Why is this important?

Antibiotics can mask the results of a blood culture and can reduce the yield of clinically useful information.

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Antibiotic Timing <6hrs for CAP

Community acquired pneumonia (CAP) patients who receive their first dose of antibiotics within 6 hours after arrival at the hospital.

Why is this important?

Clinical evidence supports that timely administration of antibiotic improves patient outcome and improves survival rates.

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Pneumococcal Vaccine for Eligible Patients

Community acquired pneumonia (CAP) patients age 65 years and older who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated.

Why is this important?

Pneumococcal vaccine is up to 75% effective in preventing Pneumococcal bacteremia and meningitis.

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O² Assessment on Arrival for CAP

Community acquired pneumonia (CAP) patients who had an assessment of oxygenation by arterial blood gas measurement or pulse oximetry on arrival to the hospital.

Why is this important?

Hypoxemia is a known risk factor for poor outcomes in pneumonia patients. O² assessment determines the need for supplemental oxygen which decreases mortality rates.

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Smoking Cessation Advice for CAP

Community acquired pneumonia (CAP) patients with a history of smoking cigarettes within the past 12 months, who are given smoking cessation advice or counseling during hospital stay.

Why is this important?

Smoking has been cited as the single greatest cause of disease in the US.

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Perfect Care for CAP

CAP patients that meet all the indicators:

• Blood culture Done Before Antibiotics Given for CAP Patients
• Initial antibiotic timing for CAP < 4 Hours
• Pneumococcal Vaccine for Eligible Patients
• O² Assessment on Arrival for CAP
• Smoking Cessation Advice for CAP

Why is this important?

Patients receiving perfect care will achieve the optimal outcome.

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Antibiotic Within 1 Hour of Surgical Incision

Number of surgical patients who received prophylactic antibiotics within 1 hour prior to surgical incision (two hours if receiving Vancomycin or a Fluoroquinolone).

Why is this important?

Antibiotics reach peak levels within about 15 minutes so the closer to the time of incision given maximizes the effect of the antibiotics and reduces the incidence of post-operative infection.

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Benchmark Information

Our quality indicators are Joint Commission core measures in which participation is a requirement not only from Joint Commission but also Centers for Medicare & Medicaid Services (CMS). Joint Commission and CMS provide facilities with national and statewide benchmarks which includes mean percentages and best deciles (top 10%) on each indicator. This data is publicly reported on Joint Commission’s website and the CMS website Hospital Compare.

These indicators represent best practice guidelines for caring for patients with heart failure, pneumonia, myocardial infarction and select surgical procedures.

How else does SOMC measure Quality?

• SOMC submits data to Volunteer Hospitals of America (VHA) so we can benchmark with all VHA hospitals.
• We participate in the Institute for Healthcare Improvement (IHI) Protecting 5 Million Lives campaign which includes the heart failure and surgical procedure indicators.
• We submit data to the National Cardiovascular Data Registry (NCDR-ACC) Action registry for all myocardial infarction patients and have benchmark reports from this registry.

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Door to P.C.I. ≤ 90 Minutes for AMI

PCI is defined as the dilation of a coronary (heart) arterial obstruction by means of a balloon catheter inserted into a narrowed blood vessel and inflated, to flatten plaque against the artery wall. This may be performed with or without a stent, a metal scaffold that is used to assist in establishing and maintaining vessel patency. Time is measured from arrival time to ED until balloon catheter is inflated.

Why is this important?

The early use of primary angioplasty in patients with acute myocardial infarction who present with ST-segment elevation or LBBB results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is. National guidelines recommend the prompt initiation of PCI.

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Appropriate Initial Antibiotic Selection for CAP

Pneumonia patients who received an initial antibiotic regimen consistent with current guidelines during the first 24 hours of their hospitalization.

Why is this important?

The current North American antibiotic guidelines for Community-Acquired Pneumonia in immunocompetent patients are from the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America (IDSA), the Canadian Infectious Disease Society/Canadian Thoracic Society (CIDS/CTS) and the American Thoracic Society (ATS). All four reflect that Streptococcus pneumoniae is the most common cause of CAP, that treatment that covers “atypical” pathogens (e.g., Legionella species, Chlamydia pneumoniae, Mycoplasma pneumoniae) can be associated with improved survival and that the prevalence antibiotic resistant S. pneumoniae is increasing. The CMS convened a conference of guideline authors to reach consensus on the antibiotic regimens that could be considered consistent with all four organizations’ guidelines. These regimens are reflected in this measure and in the Pneumonia Antibiotic Censensus Recommendation.

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Influenza Vaccine for Eligible Patients (Oct 1st – Mar 31st)

Community acquired pneumonia (C.A.P.) patients age 50 years and older who were screened for influenza vaccine status and were administered the vaccine prior to discharge, if indicated.

Why is this important?

People who are vaccinated are 44% or higher less likely to get influenza (CDC 2007 report)

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Foley Catheter Removed on POD 1 or POD 2

Surgical patients with urinary catheter removed on postoperative Day 1 or Postoperative Day 2 with day of surgery being day zero.

Why is this important?

Surgical patients who have indwelling bladder catheters for more than 2 days postoperatively are more likely to develop UTI, significantly less likely to be discharged to home and have a significant increase in mortality at 30 days.

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Normothermia on all Surgical Patients

Surgery patients for whom either active warming was used intraoperatively for the purpose of maintaining Normothermia or who had at least one body temperature equal to or greater than 96.8° F/36° C recorded within the 30 minutes immediately prior to or the 15 minutes immediately after Anesthesia End Time.

Why is this important?

Core temperatures outside the normal range pose a risk in all patients undergoing surgery. According to the clinical guidelines for the Prevention of Unplanned Perioperative hypothermia by the American Society of PeriAnesthesia Nurses (ASPAN, 2001, published research has correlated impaired would healing, adverse cardiac events, altered drug metabolism, and coagulopathies with unplanned perioperative hypothermia.

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Normothermia on Colorectal Surgeries

Surgery patients for whom either active warming was used intraoperatively for the purpose of maintaining Normothermia or who had at least one body temperature equal to or greater than 96.8° F/36° C recorded within the 30 minutes immediately prior to or the 15 minutes immediately after Anesthesia End Time.

Why is this important?

Core temperatures outside the normal range pose a risk in all patients undergoing surgery. According to the clinical guidelines for the Prevention of Unplanned Perioperative hypothermia by the American Society of PeriAnesthesia Nurses (ASPAN, 2001, published research has correlated impaired would healing, adverse cardiac events, altered drug metabolism, and coagulopathies with unplanned perioperative hypothermia.

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Prophylactic Antibiotic Discontinued Within 24 Hours for Surgery Patients

Patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time (48 hours for CABG or other Cardiac Surgery).

Why is this important?

A goal of prophylaxis with antibiotics is to provide benefit to the patient with as little risk as possible. It is important to maintain therapeutic serum and tissue levels throughout the operation. Intraoperative re-dosing may be needed for long operations. However, administration of antibiotics for more than a few hours after the incision is closed offers no additional benefit to the surgical patient. Prolonged administration does increase the risk of Clostridium difficile infection and the development of antimicrobial resistant pathogens.

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Appropriate Prophylactic Antibiotic Selection for Surgery Patients

Includes surgical inpatients with a principal procedure code of colorectal resection, hysterectomy, total hip and knee replacements, major vascular procedures.

Why is this important?

A goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective and has a spectrum of action that covers most of the probable intraoperative contaminants for the operation. First or second-generation cephalosporins satisfy these criteria for most operations, although anaerobic coverage is needed for colon surgery. Vancomycin is not recommended for routine use because of the potential for development of antibiotic resistance, but is acceptable if a patient is allergic to beta-lactams, as are fluoroquinolones and clindamycin.

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Surgery Patients With Appropriate Hair Removal

Surgery patients with surgical site hair removal with clippers or depilatory or with no surgical site hair removal.

Why is this important?

Studies show that shaving causes multiple skin abrasions that later may become infected. Adult patients undergoing surgeries reported a significantly higher rate of infection among patients who were shaved with a razor than those who had hair removal by electric clippers before skin incision. In a systematic literature review there was no strong evidence to contraindicate preoperative hair removal; however, there was strong evidence against hair removal with a razor. This review recommended depilatory or electric clippers immediately prior to surgery when hair removal was required. Clippers used on the morning of surgery, resulted in reduced surgical site infections and healthcare expenditures.

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Major Cardiac Patients with Controlled (<200 mg/dl) 6am Post-op Serum Glucose on POD 1 and POD 2

Major cardiac patients with controlled 6 AM blood glucose (≤200 mg/dL) on postoperative day one (POD1) and postoperative day two (POD2) with Surgery End Date being postoperative day zero (POD0).

Why is this important?

Hyperglycemia has been associated with increased in-hospital morbidity and mortality for multiple medical and surgical conditions. The risk of infection was significantly higher for patients undergoing major cardiac procedure if blood glucose levels were elevated and demonstrated that the incidence of deep wound infections in diabetic patients undergoing cardiac surgery was reduced by controlling mean blood glucose levels below 200 mg/dL in the immediate postoperative period. Hyperglycemia in the immediate postoperative phase increases the risk of infection in both diabetic and nondiabetic patients and the higher the level of hyperglycemia, the higher the potential for infection in both patient populations. Intensive insulin therapy not only reduced overall in-hospital mortality but also decreased blood stream infections, acute renal failure, red cell transfusions, ventilator support and intensive care.

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Surgery Patients on Beta Blockers Prior to Admission Who Receive Beta Blocker During Perioperative Period

The perioperative period for the SCIP Cardiac measures is defined as 24 hours prior to surgical incision through discharge from post-anesthesia care/recovery area.

Why is this important?

In patients at risk of cardiovascular complications in a variety of medical conditions, beta-blockers have shown to reduce that risk. Studies show that patients with a history of myocardial infarction who have had beta-blocker therapy initiated and continued, have a 20 to 30% reduction in subsequent coronary events, cardiovascular mortality and all-cause mortality, long-term cardiac mortality and myocardial ischemia were reduced significantly by perioperative beta blockade. Patients maintained on beta-blockers, without complications that might warrant discontinuation, are good candidates for continuation of beta-blockers through the perioperative period.

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VTE Prophylaxis Ordered for Surgery Patients

Surgery patients who received appropriate venous thromboembolism (VTE) prophylaxis within 24 hours prior to Surgical Incision Time to 24 hours after Surgery End Time.

Why is this important?

Despite the evidence that VTE is one of the most common postoperative complications and prophylaxis is the most effective strategy to reduce morbidity and mortality, it is often underused. The frequency of, that includes deep vein thrombosis and pulmonary embolism, is related to the type and duration of surgery, patient risk factors, duration and extent of postoperative immobilization and use or nonuse of prophylaxis. Studies have shown that appropriately used thromboprophylaxis has a positive risk/benefit ratio and is cost effective.

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VTE Prophylaxis Received Within 24 Hours Prior to or After Surgery

Surgery patients who received appropriate venous thromboembolism (VTE) prophylaxis within 24 hours prior to Surgical Incision Time to 24 hours after Surgery End Time.

Why is this important?

Despite the evidence that VTE is one of the most common postoperative complications and prophylaxis is the most effective strategy to reduce morbidity and mortality, it is often underused. The frequency of, that includes deep vein thrombosis and pulmonary embolism, is related to the type and duration of surgery, patient risk factors, duration and extent of postoperative immobilization and use or nonuse of prophylaxis. Studies have shown that appropriately used thromboprophylaxis has a positive risk/benefit ratio and is cost effective.

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Systemic Corticosteroids for Inpatient (age 2–17) Overall Rate

Documentation that the patient received oral or intravenous (Systemic) corticosteroids for asthma exacerbation during this inpatient hospitalization. Inpatient hospitalization includes the time from arrival to the emergency department (ED) or observation area until discharge form the inpatient setting.

Systemic corticosteroids (oral or intravenous corticosteroids) are recommended as short term or rescue medications to relieve bronchoconstriction rapidly, making them useful in gaining quick initial control of asthma and in treatment of moderate to severe asthma exacerbations.

Why is this important?

Asthma is the most common chronic disease in children and a major cause of morbidity and increased health care expenditures nationally. For children, asthma is one of the most frequent reasons for admission to hospitals. Undertreatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. Use of systemic corticosteroids are recommended to gain control of acute asthma exacerbation and reduce asthma.

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Relievers for Inpatient (age 2–17) Overall Rate

Documentation that the patient received reliever medication(s) for asthma exacerbation during this hospitalization. Inpatient hospitalization included the time from arrival to the emergency department (ED) or observation area until discharge from the inpatient setting.

Relievers are medications that relax the bands of muscle surrounding the airways and are used to quickly alleviate bronchoconstriction and prevent exercise-induced bronchospasm.

Why is this important?

Asthma is the most common chronic disease in children and a major cause of morbidity and increase health care expenditures nationally. For children, asthma is one of the most frequent reasons for admission to hospitals. Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. Use of relievers are recommended to gain control of acute asthma exacerbation and reduce severity as quickly as possible.

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Venous Thromboembolism (VTE) Prophylaxis

Ischemic and hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission.

Why is this important?

Stoke patients are at increased risk of developing venous Thromboembolism (VTE). Prevention of VTE, through the use of prophylactic therapies, in at risk patients is a noted recommendation in numerous clinical practice guidelines. Aspirin alone is not recommended as an agent to prevent VTE.

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Discharged on Antithrombotic Therapy

Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge

Why is this important?

The effectiveness of antithrombotic agents in reducing stoke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. Warfarin is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke.

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Anticoagulation Therapy for Atrial Fibrillation/Flutter

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge

Why is this important?

Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. Prevention strategies focus on the modifiable risk actors such as hypertension, smoking, and atrial fibrillation. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke r3eisk-atrial fibrillation patient with TIA or prior stroke.

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Thrombolytic Therapy

Acute Ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well

Why is this important?

The administration of thrombolytic agents to carefully screened, eligible patients with acute ishemic stroke has been shown to be beneficial in several clinical trials.

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Antithrombotic Therapy by end of Hospital Day 2

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2.

Why is this important?

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2.

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Discharged on Statin Medication

Ischemic stroke patients with LDL ≥ 100 mg/dL, or LDL not measured, or, who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge.

Why is this important?

Initial studies have demonstrated that intensive lipid lowering therapy using statin medication was associated with a dramatic reduction in the rate of recurrent ischemic stroke and major coronary events. As a result, intensive lipid lowering therapy through use of a statin medication is now recommended for all patients with stroke or TIA of atherosclerotic origin who have an LDL ≥ 100 mg.dl (or with LDL < 100 mg/dl due to being on lipid lowering therapy prior to admission)

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Stroke Education

Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medication prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke.

Why is this important?

Education increases healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Patient education should include information about the event (e.g., cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve strategies appropriate to the patient’s prognosis and potential for rehabilitation.

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Assessed for Rehabilitation

Ischemic or hemorrhagic stroke patients who wee assessed for rehabilitation services.

Why is this important?

Stroke is a leading cause of serious, long-term disability in the United States, with about 4.4 million stroke survivors alive today. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. The primary foal of rehabilitation is to prevent complication, minimize impairments, and maximize function.

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Appropriate Prophylactic Antibiotic Initiated Within One Hour Prior to Surgical Incision

Surgical patients who received prophylactic antibiotics within 1 hour prior to surgical incision (two hours if receiving Vancomycin or a Fluoroquinolone.

Why is this important?

Antibiotics reach peak levels within about 15 minutes so the closer to the time of incision given maximizes the effect of the antibiotics and reduces the incidence of post-operative infection.

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Appropriate Prophylactic Antibiotic Selection for Surgical Patients

These are outpatients that are dismissed from SDS or placed in observation and discharged the next day. Some procedures included are LAVH, Lap GB≥70 years old, podiatric procedures (hammertoe repair), uterine suspensions, ORIF foot, ankle, hand fractures.

Why is this important?

A goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective and has a spectrum of action that covers most of the probable intraoperative contaminants for the operation. First or second-generation cephalosporins satisfy these criteria for most operations, although anaerobic coverage is needed for colon surgery. Vancomycin is not recommended for routine use because of the potential for development of antibiotic resistance, but is acceptable if a patient is allergic to beta-lactams, as are fluoroquinolones and clindamycin.

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Aspirin at Arrival for Chest Pain/AMI

Cardiac chest pain patients/Acute Myocardial Infarction (AMI) patients without contraindications who received aspirin within 24 hours before or after hospital arrival.

Why is this important?

Aspirin has an antiplatelet activity which can prevent decreased blood flow

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Median Time in Minutes to ECG for Chest Pain/AMI

Time is calculated from arrival time to EKG performed in the ED prior to transfer to another acute care facility or placed in observation status.

Why is this important?

Guidelines recommend patients presenting with chest discomfort/symptoms suggestive of ST-segment elevation have a 12-lead electrocardiogram (ECG) performed within a target of 10 minutes of emergency department arrival. Evidence supports reperfusion benefits patients with identification of ST-segment elevation myocardial infarction. The diagnosis and management of ST-segment elevation myocardial infarction (STEMI) patients is dependent upon practices within the emergency department. Timely ECGs assist in identifying STEMI patients and impact the choice of reperfusion strategy.

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Median Time in Minutes to Transfer to Another Facility for Acute Coronary Intervention AMI

Time is calculated from ED arrival to time transferred to another facility for acute coronary intervention for STEMI patients only. Physician must document in the record that patient is being transferred from the ED to another acute care facility specifically for intervention (PCI or CABG).

Why is this important?

The early use of primary angioplasty in patients with acute myocardial infarction who present with ST-segment elevation or LBBB results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is. National guidelines recommend the prompt initiation of PCI in patients presenting with ST-segment elevation myocardial infarction. Patients transferred for primary PCI rarely meet recommended guidelines for door-to-balloon time. Times to treatment in transfer patients undergoing primary PCI may influence the use of PCI as an intervention. Current recommendations support a door-to-balloon time of 90 minutes or less.

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Participation in a Systematic Database for Cardiac Surgery

This N.Q.F. endorsed measure relates to CABG and open heart procedures patients. SOMC will participate in the Society Thoracic Surgeons (STS) Adult Cardiac National database which is an N.Q.F. approved registry.

The Society of Thoracic Surgeons is a not-for-profit organization representing more than 5,600 surgeons, researchers and allied health professionals worldwide who are dedicated to ensuring the best possible heart, lung, esophageal and other surgical procedures for the chest. Founded in 1964, the mission of STS is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research and advocacy.

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Statin at Discharge for AMI

Statin drugs reduce the risk of death and recurrent cardiovascular events in a broad range of patients with established cardiovascular disease, including those with prior myocardial infarction.

Current ACC/AHA guidelines place a strong emphasis on the initiation or maintenance of statin drugs for patients hospitalized with AMI, particularly those with LDL-cholesterol levels above 100 mg/dL

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Participation in a PCI Registry

The ACC-NCDR cardiac catheterization and percutaneous intervention (PCI) registry has been operating since November 1998 offering hospitals a powerfull tool to measure quality in their cardiac catheterization Laboratory (Cath Lab). ACC-NCDR provides participating cath labs the ability to measure performance including adverse events and risk-adjusted PCI mortality rates, and compare their performance to national and like-hospitals. Since the ACC-NCDR’s inception it has grown to represent nearly 500 hospitals and houses 1.7 million patient records, of which650,000 include PCI procedure.

Anthem will require participation in and data submission via the ACC-NCDR and STS National Registry.

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Participation in a Systematic Clinical Database for Nursing Sensitive Care

Participation in NDNQI.

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