Pennsylvania Health Care Quality Alliance (PHCQA)

Quality Measures > Appropriate Care

Appropriate Care

The Appropriate Care Measure (ACM) is a patient-centered composite score that summarize whether patients received all of the recommended treatments (appropriate or correct care) that they should have received, based on their specific conditions. Since each patient is unique and may not be eligible for every type of care for a condition, the ACM scores take patient individuality into consideration, looking at each patient and his care one episode at a time. It is an ‘all or none’ measure so only patients who received all of the recommended care are included in the score.

The Appropriate Care Measures include four topic-specific scores (heart attack, heart failure, pneumonia, and surgical care and infection prevention (SCIP)), as well as an Overall ACM score. The Overall ACM score will account for 25 possible treatments (7 Heart Attack, 4 Heart Failure, 6 Pneumonia and 8 SCIP treatments) for hospital patients. Prior to April 2009, the Overall ACM score was calculated based on 26 possible treatments (include an additional AMI treatment), and prior to January 2009, the Overall ACM score was calculated based on 26 possible treatments (one more Pneumonia treatment and one less SCIP treatment). For a full list of all historical ACM methodology changes, please contact PHCQA.

Each patient who enters a hospital with a diagnosis in one of the four above-listed clinical areas and is eligible for at least one of the treatments for that condition will be counted in the denominator of that topic-specific ACM score. (If the patient enters the hospital exhibiting more than one of the four clinical conditions, that patient will only be counted as a denominator for the primary condition that caused admission to the hospital.) If that patient receives all of the treatments for which he is eligible, he will be included in the numerator of the topic-specific ACM score; if he does not receive all of the treatments for which he is eligible, he will not be counted. At the end of the given time period, the number of patients that received all of the proper treatments for their clinical condition will be divided by the total number of patients entering the hospital with that condition (who were eligible for at least one of the treatments). This will produce each topic-specific ACM score. The Overall ACM score will add all of the “numerators” for the four clinical categories and divide that sum by the total number of patients entering the hospital that were eligible for at least one of the 26 treatments indicated in the measure.

Measures in this category

Overall Appropriate Care: Total percentage of heart attack, heart failure, pneumonia, and surgical care patients who received all recommended treatments based on their clinical condition.

Heart Attack Care: Percent of heart attack patients who received all recommended treatments based on their clinical condition.

The following is the list of the seven underlying measures that make up the Heart Attack Appropriate Care Measure. (To be counted in the Heart Attack Appropriate Care Score, the heart attack patient should be eligible for at least one of the following treatments):

• Aspirin on Arrival: Percent of heart attack patients with no medical reason not to take aspirin who received aspirin within 24 hours before or after hospital arrival. (Source: CMS)
• Aspirin Prescribed at Discharge: Percent of heart attack patients with no medical reason not to take aspirin who were prescribed aspirin at hospital discharge. (Source: CMS)
• ACEI or ARB for LVSD: Percent of heart attack patients with left ventricular systolic dysfunction (LVSD) and no medical reason not to take either angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) who were prescribed an ACEI or an ARB at hospital discharge. (Source: CMS)
• Adult Smoking Cessation Advice/Counseling: Percent of heart attack patients who received smoking cessation advice/counseling. (Source: CMS)
• Beta Blocker Prescribed at Discharge: Percent of heart attack patients with no medical reason not to take a beta blocker medication who were prescribed a beta blocker medication at hospital discharge. (Source: CMS)
• Fibrinolytic Therapy within 30 Minutes: Percent of heart attack patients given fibrinolytic medication within 30 minutes of arrival to the hospital. (Source: CMS)
• PCI within 90 Minutes: Percent of heart attack patients receiving Percutaneous Coronary Intervention (PCI) during the hospital stay within 90 minutes of arrival to the hospital. (Source: CMS)

Heart Failure Care: Percent of heart failure patients who received all recommended treatments based on their clinical condition.

The following is the list of the four underlying measures that make up the Heart Failure Appropriate Care Measure. (To be counted in the Heart Failure Appropriate Care Score, the heart failure patient should be eligible for at least one of the following treatments):

• Discharge Instructions: Percent of heart failure patients discharged home with written instructions or educational material given to patient or care giver at discharge or during the hospital stay addressing all of the following: activity level, diet, discharge medications, follow-up appointment, weight monitoring, and what to do if symptoms worsen. (Source: CMS)
• Evaluation of LVS Function: Percent of heart failure patients receiving an evaluation of Left Ventricular Systolic (LVS) function. (Source: CMS)
• ACEI or ARB for LVSD: Percent of heart failure patients with left ventricular systolic dysfunction (LVSD) and with no medical reason not to take either angiotensin converting enzyme inhibitor (ACEI) medication or angiotensin receptor blocker (ARB) medication who are prescribed an ACEI or an ARB at hospital discharge. (Source: CMS)
• Adult Smoking Cessation Advice/Counseling: Percent of heart failure patients who received smoking cessation advice/counseling. (Source: CMS)

Pneumonia Care: Percent of pneumonia patients who received all recommended treatments based on their clinical condition.

The following is the list of the six underlying measures that make up the Pneumonia Appropriate Care Measure. (To be counted in the Pneumonia Appropriate Care Score, the pneumonia patient should be eligible for at least one of the following treatments):

• Pneumoccocal Vaccination: Pneumonia inpatients age 65 and older who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated. (Source: CMS)
• Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital: Percent of pneumonia patients whose initial emergency room blood culture specimen was collected prior to first hospital dose of antibiotics. (Source: CMS)
• Adult Smoking Cessation Advice/Counseling: Percent of pneumonia patients who received smoking cessation advice/counseling. (Source: CMS)
• Initial Antibiotic within 6 Hours: Percent of pneumonia patients who receive an antibiotic within 6 hours of arrival to the hospital. (Source: CMS)
• Initial Antibiotic Selection: Percent of immunocompetent patients with pneumonia who receive an initial antibiotic regimen that is consistent with current guidelines. (Source: CMS)
• Influenza Vaccination: Percent of pneumonia patients age 50 years and older, hospitalized during October, November, December, January, or February who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated. (Source: CMS)

Surgical Care: Percent of surgical care patients who received all recommended treatments based on their clinical condition.

The following is the list of the eight underlying measures that make up the Surgical Care Appropriate Care Measure. (To be counted in the Surgical Care Appropriate Care Score, the surgical patient should be eligible for at least one of the following treatments):

• Beta Blocker during the Perioperative Period: Percent of surgery patients who were taking heart drugs called beta blockers before coming to the hospital, who were kept on the beta blockers during the period just before and after their surgery. (Source: CMS)
• Prophylactic Antibiotic within 1 hour of incision: Percent of Surgical patients who received prophylactic antibiotics within 1 hour prior to surgical incision. (Source: CMS)
• Prophylactic Antibiotic Selection for Surgical Patients: Percent of Surgical patients who received the appropriate prophylactic antibiotic(s) for their surgery. (Source: CMS)
• Prophylactic Antibiotic Discontinued within 24 hours: Percent of surgical patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time. (Source: CMS)
• Cardiac Surgery Patients with Controlled 6 A.M. Postoperative Blood Glucose: Percent of all heart surgery patients whose blood sugar (blood glucose) is kept under good control in the days right after surgery. (Source: CMS)
• Surgery Patients with Appropriate Hair Removal: Percent of surgery patients needing hair removed from the surgical area before surgery, who had hair removed using a safer method (electric clippers or hair removal cream – not a razor). (Source: CMS)
• VTE Ordered prior to Surgery: Percent of surgery patients whose physicians ordered treatment to prevent blood clots (Venous Thromboembolism Prophylaxis) when appropriate. (Source: CMS)
• VTE Received within 24 Hours of Surgery: Percent of surgery patients who received treatment to prevent blood clots (Venous Thromboembolism Prophylaxis) within 24 hours before or after surgery when appropriate. (Source: CMS)