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  • Measure Summary
  • NQMC:008441
  • Mar 2011

Cardiac care: percentage of patients with ST-segment elevation acute coronary syndrome (STE-ACS) and primary PTCA and door-balloon time less than 90 minutes.

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients with ST-segment elevation acute coronary syndrome (STE-ACS) and primary percutaneous transluminal coronary angioplasty (PTCA) who arrive at the hospital soon with a large infarct and who have door-balloon time less than 90 minutes.

Rationale

The aim of intensive care medicine is to provide critical patients with the healthcare that they need, ensuring the quality and safety of care. Intensive care medicine is one of the principal components of modern healthcare systems. There is an increasing demand for this resource, which involves high costs.

The quality of care has gradually come to be the central focus of healthcare, and in recent years patient safety has come to represent one of the key aspects of quality. In the case of intensive care medicine, this interest in quality is even more evident, not only because of its social and economic impact, but also because some of the dimensions involved in the quality of care of critical patients take on greater importance: critical patients are more vulnerable, access to critical care is more limited so efforts to distribute resources equitably are more important, scant scientific evidence is available, and the efficiency is limited.

Primary percutaneous transluminal coronary angioplasty (PTCA) is the treatment of choice for ST-segment elevation acute coronary syndrome (STE-ACS) provided it is done early by an experienced team. The recommended time from first medical contact (FMC) to balloon dilation is less than 2 hours in all cases and less than 90 minutes in patients that reach the hospital soon after an extensive infarct.

Evidence for Rationale

Felices-Abad F, Latour-Perez J, Fuset-Cabanes MP, Ruano-Marco M, Cunat-de la Hoz J, del Nogal-Saez F, Grupo Ariam. Quality indicators in the acute coronary syndrome for the analysis of the pre- and in-hospital care process. Med Intensiva. 2010 Aug-Sep;34(6):397-417. PubMed External Web Site Policy

Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO, American College of Cardiology Foundation/American Heart Association Task Force. 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 F. Circulation. 2009 Dec 1;120(22):2271-306. PubMed External Web Site Policy

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Rosell Ortiz F, Mellado Vergel FJ, Ruiz Bailen M, Garcia Alcantara A, Reina Toral A, Arias Garrido J, Alvarez Bueno M, Grupo Cardiologico de EPES, Grupo ARIAM de Andalucia. [Acute coronary syndrome (ACS) with elevated ST segment: consensus strategy for early reperfusion. The Public Enterprise for Health Emergencies and the ARIAM Project Andalusia]. Med Intensiva. 2007 Dec;31(9):502-9. [29 references] PubMed External Web Site Policy

Primary Health Components

Cardiac care; ST-segment elevation acute coronary syndrome (STE-ACS); primary percutaneous transluminal coronary angioplasty (PTCA); extensive infarct; door-balloon time

Denominator Description

Number of patients with ST-segment elevation acute coronary syndrome (STE-ACS) and primary percutaneous transluminal coronary angioplasty (PTCA) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with door-balloon time less than 90 minutes (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Emergency Department

Hospital Inpatient

Intensive Care Units

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Timeliness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of patients with ST-segment elevation acute coronary syndrome (STE-ACS) and primary percutaneous transluminal coronary angioplasty (PTCA)

Population: All patients with STE-ACS and primary PTCA discharged from the critical care department.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patients with door-balloon time less than 90 minutes*

Note:

  • Door-balloon time: Time from the patient's arrival to balloon inflation in percutaneous transluminal coronary angioplasty (PTCA).

*Less than 90 minutes: Patients who arrive at the hospital soon (within 2 hours) with a large infarct and low risk of bleeding.

    Exclusions
    Unspecified

    Numerator Search Strategy

    Institutionalization

    Data Source

    Electronic health/medical record

    Paper medical record

    Registry data

    Type of Health State

    Does not apply to this measure

    Instruments Used and/or Associated with the Measure

    Unspecified

    Measure Specifies Disaggregation

    Does not apply to this measure

    Scoring

    Rate/Proportion

    Interpretation of Score

    Desired value is a higher score

    Allowance for Patient or Population Factors

    Unspecified

    Standard of Comparison

    Internal time comparison

    Prescriptive standard

    Prescriptive Standard

    Standard: 100%

    Evidence for Prescriptive Standard

    Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

    Original Title

    Door-balloon time in primary percutaneous transluminal coronary angioplasty (PTCA).

    Measure Collection Name

    Quality Indicators in Critically Ill Patients

    Measure Set Name

    Cardiac Care and Cardiopulmonary Resuscitation (CPR)

    Submitter

    Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

    Developer

    Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

    Funding Source(s)

    Boehringer Laboratories

    Composition of the Group that Developed the Measure

    Work Group for Cardiac Care and Cardiopulmonary Resuscitation (CPR)

    • Ma Paz Fuset Cabanes
    • Miguel Ruano Marco
    • Josep Ma Alcoverro Pedrola
    • Jaime Latour Pérez
    • José Cuñat de la Hoz
    • Frutos del Nogal Sáez
    • Francisco Felices Abad
    • Juan López Messa
    • Emilia Civeira Murillo
    • María Dolores Carrasco González
    • Antonio José Montón Rodríguez

    Scientific Coordination:

    • Maria Cruz Martín Delgado
    • Jesús Blanco Varela
    • Lluís Cabré Pericas
    • Pedro Galdos Anuncibay
    • Federico Gordo Vidal

    Financial Disclosures/Other Potential Conflicts of Interest

    Unspecified

    Adaptation

    This measure was not adapted from another source.

    Date of Most Current Version in NQMC

    2011 Mar

    Measure Maintenance

    Unspecified

    Date of Next Anticipated Revision

    2016 Jul

    Measure Status

    This is the current release of the measure.

    The measure developer reaffirmed the currency of this measure in May 2016.

    Source(s)

    Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

    Measure Availability

    Source available in English External Web Site Policy and Spanish External Web Site Policy from the Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC) Web site.

    For more information, contact SEMICYUC at Paseo de la Reina Cristina, 36, 4o D, Madrid, Spain; Phone: +34-91-502-12-13; Fax: +34-91-502-12-14; Web site: www.semicyuc.org External Web Site Policy; E-mail: secretaria@semicyuc.org.

    NQMC Status

    This NQMC summary was completed by ECRI Institute on November 18, 2013. The information was verified by the measure developer on February 6, 2014.

    The information was reaffirmed by the measure developer on May 10, 2016.

    Copyright Statement

    This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

    The Quality Indicators in Critically Ill Patients update 2011 can be used by any private or public body only for the purposes of research, clinical management, teaching and education, and will not be used for any other purpose. In all cases, full credit to the Spanish Society of Intensive Care Medicine (SEMICYUC) will be granted. The commercial use of the Quality Indicators in Critically Ill Patients update 2011 is explicitly forbidden.

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