Pennsylvania Health Care Quality Alliance (PHCQA)

Topic: Appropriate Care Heart Attack Heart Failure Pneumonia Surgical Care and Infection Prevention Consumer Assessment An appropriate care measure (ACM) is a score that assesses what percentage of patients (with a specified clinical condition) received all of the clinical interventions deemed appropriate under the circumstances. The appropriate care measures include four topic-specific scores (heart attack, heart failure, pneumonia, and surgical care), as well as an overall ACM score. The overall ACM score accounts for 25 possible treatments^ (7 Heart Attack, 4 Heart Failure, 6 Pneumonia, and 8 SCIP treatments) for hospital patients.

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 a patient enters the hospital exhibiting more than one of the four clinical conditions, the 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 they are eligible, they will be included in the numerator of the topic-specific ACM score; if they do not receive all of the treatments for which they are eligible, they will not be counted in the numerator of that topic-specific ACM score. 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 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 25 treatments indicated in the measure.

^Starting in April 2009, one measure was removed from the heart attack category, thereby decreasing the total number of measures included in the ACM score to twenty-five. Prior to this date, twenty-six measures were included.

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