Core Options Review

1
Core Options Review

• Changes effective with October 1, 2006 discharges

2
Agenda

• Timeframe for October release notes
• Review general program changes
• Brief overview of October 2006 discharges
• General abstraction changes
• SCIP
• PN
• Review of July discharges
• SIP to SCIP Transition
• Sampling

3
Timeframe

• Beta sites currently reviewing tool
• Want to join
• You must be ready to abstract October discharges
• You must be able to get automatic updates
• If you are part of a multi-hospital system all
  facilities must agree to participate
• General release scheduled for October 26th
• Third Quarter data due December 15th
• Fourth Quarter data due March 15th

4
General Abstraction

• Demographic
• Patient HIC
• Change valid length to 7-12 characters
• Suggested Data Sources
• Form Locators for some data elements may change
  with the implementation of the UB-04

5
Unknown and Missing Data Elements

• Unknown times
• Antibiotic and blood culture times
• Leave empty and Core Options will populate with
  9999 during transmission to the QNET Warehouse
• Miscellaneous data elements
• Temperature Value, Glucose POD 1 and Glucose POD
  2
• Use 9999 to indicate that the value was not
  recorded

6
Discharge Instruction - HF

• Applies to all 6 discharge instruction questions
• Clarification on use of electronically formatted
  media such as videos, CDs, and DVDs
• Use only the documentation provided in the
  medical record itself. If literature is located
  outside of the medical record, it should not be
  reviewed and used in abstraction.
• Documentation must clearly convey that (1)
  instructions regarding discharge instruction
  category, e.g., "activity" are included in the
  material, and (2) the patient was given a copy to
  take home.

7
Pneumonia

• New data elements
• Another Suspected Source of Infection
• Collected for antibiotic selection PN-6a and
  PN-6b
• If there was another suspected source of
  infection in addition to pneumonia upon admission
  then the patient is excluded from the measure
  set.
• Pneumonia Diagnosis ED/Direct Admit
• Replaces Working Diagnosis on Admission
• Collected for PN-1, PN-3a, PN-3b, PN-5 and PN-6
• Separates emergency room from direct admit within
  the algorithm
• Direct Admit (2) will be excluded from PN-3b

8
Retired or Revised Data Elements

• Retired data elements
• Antibiotics Prior to Arrival
• Pneumonia Working Diagnosis on Admission
• Revised data elements
• Antibiotic Received
• Revised notes for abstraction
• Comfort Measures Only
• Healthcare Associated PN
• Pneumococcal Vaccine Status
• Pseudomonas Risk
• Clinical Trial
• Pneumonia Antibiotic Consensus Recommendations
  changes

9
Algorithm changes

• PN-3b
• Only records with an admit source of 7 will be
  included
• Blood culture collected after arrival removed
• PN-6, PN-6a and PN-6b
• Pneumonia Antibiotic Consensus Recommendations
  changes
• Parenteral Quinolones is now used for ICU
  patients
• Quinolones is only applicable for Non-ICU because
  it contains an oral quinolone
• Changes to medication tables

10
Antibiotic Abstraction Guidelines

• Collect only antibiotics administered via an
  appropriate route
• (SCIP-Inf PO and IV PN PO, IV and IM)
• In narrative documentation, only accept
  documentation that reflects the actual
  administration of the antibiotic. The use of
  "hang time" or "infusion time" is acceptable ONLY
  on the ED record when other documentation cannot
  be found.
• Core Options edit for antibiotics that are more
  than 15 minutes prior

11
Antibiotic Table Changes

• PN
• New Table 2.14 Quinolones Parenteral
• PN and SCIP
• Table 2.1 Antimicrobial Medications Table
• Table 2.2 Immunosuppressive Medications
• Table 4.0 Antibiotic Allergy Table
• SCIP
• Table 3.1 Cardiac or Vascular
• Table 3.5 Colon - Parenteral
• Table 3.7 Hysterectomy

12
SCIP General Changes

• Core Options will only look at the principal
  procedure for inclusion into the SCIP measure set
  
• Patients whose ICD-9-CM principal procedure
  occurred prior to the date of admission are now
  excluded
• Admitting diagnosis code is no longer an
  exclusion for infection. Only principal
  diagnosis codes will be accepted
• Surgery Start Date is now collected for all SCIP
  measures.

13
SCIP

• New Indicators
• Cardiac  
• SCIP-Card-2
• Surgery Patients on Beta Blocker Therapy Prior to
  Admission Who Received a Beta Blocker During the
  Perioperative Period
• VTE  
• SCIP-VTE-1
• Surgery Patients with Recommended Venous
  Thromboembolism Prophylaxis Ordered
• SCIP-VTE-2
• Surgery Patients Who Received Appropriate Venous
  Thromboembolism Prophylaxis Within 24 Hours Prior
  to Surgery to 24 Hours After Surgery

14
Retired Data Elements

• Retired data elements
• Admission Diagnosis of Infection
• Antibiotics During Stay
• Antibiotics Prior to Arrival
• Early Antibiotics
• Infection Procedure of Interest
• Surgery Performed During Stay

15
New data elements

• SCIP Cardiac data elements
• Beta Blocker Current Medication
• Beta Blocker Perioperative
• Contraindication to Beta Blocker - Perioperative
• Perioperative Death
• SCIP VTE data elements
• Contraindication to VTE Prophylaxis
• Discharge Time
• Documented Bleeding Risk
• Neuraxial Anesthesia
• Preadmission Warfarin
• VTE Laparoscope
• VTE Prophylaxis
• VTE Timely

16
Revised data elements

• Surgical incision time
• Intraop Death
• Surgery End Date and Time
• Surgery Start Date and Incision Time
• Temperature Value
• Vancomycin
• Glucose POD 1 Glucose POD 2
• Postoperative Infections
• Infection Prior to Anesthesia
• Other Surgeries

17
ICD-9 Code Changes

• Table 5.06 Abdominal Hysterectomy
• Remove procedure codes
• 68.4, 68.6
• Add procedure codes
• 68.49, 68.69
• Table 5.07 Vaginal Hysterectomy
• Remove procedure code
• 68.7
• Add procedure code
• 68.79

18
SCIP algorithm changes

• SCIP-inf-2
• Prophylactic Antibiotic Regimen Selection for
  Surgery
• Remove Cefamandole and Cefmetazole from the
  tables
• SCIP-inf-3
• Two new processes have been added to the
  flowchart for SCIP-Inf-3. These processes remove
  from consideration any antibiotic doses
  administered more than two days after surgery
  ended (three days for CABG and Other Cardiac
  surgeries)
• SCIP-inf-7
• Change the Numerator Statement to read Surgery
  patients whose first recorded temperature was
  greater than or equal to 96.8 º F within the
  first hour after leaving the operating room

19
SCIP Flowchart
Initial SCIP Population Principal ICD-9 Procedure
Code Table 5.10
20
SIP to SCIP Transition

• Why the sudden increase in cases?
• Creation of a new surgery type called Major
  Surgery
• Eligible for only SCIP-inf-4,6,7 as appropriate
  and for CARD-2 and VTE-1 and 2 with October
  discharges
• Why are non-surgical cases such as 3rd and 4th
  degree laceration included?
• The ICD-9 population is defined by JCAHO and CMS
  as all records with either a principal or
  secondary procedure found in Table 5.10
• Table is currently being reviewed and an update
  is expected in April 2007

21
SIP to SCIP Transition

• Do I have to do the new indicators?
• Officially the answer is no
• SCIP-Inf-4, 6 and 7 are not endorsed by the
  National Quality Forum
• Hospitals can elect to skip questions relevant to
  SCIP-Inf-4, 6 and 7, and Core Options will
  submit only SCIP-Inf-1, 2 and 3 to both JCAHO and
  CMS
• What if I choose not to?
• Contact either Laurie Morris or myself
• For October discharges forward you can change
  your facility settings
• Contact JCAHO if you have elected SCIP as a
  measure set to let them know so they can adjust
  their selection report

22
SIP to SCIP Transition

• I normally do 100 of SIP and now have too many
  cases. Can I sample just Major Surgery
• Yes, sampling is done per surgery type.
• You can continue to do 100 of your normal
  surgeries and sample the new Major Surgery type
• How do I create a sample?
• You cannot create your own sample
• You need to turn on sampling with the Facility
  Settings section and then create the sample for
  each surgery type within the abstract module

23
Creating a SCIP Sample Set-up

• Set-up SCIP to allow for sampling
• Go to TOOLSgtAdministrative and select Facility
  SettingsgtSelected Measures Tab
• If it is grayed out then you do not have
  sufficient rights within Core Options
• Contact the administrator within your facility
• Select each instance of SCIP and select Edit
  Measure
• All you need to do is check the Allow Sampling
  for this measure and click the Save Button
• Exit this area by selecting the Facility
  Settings in the upper left hand corner

24
Creating the Sample Abstract Module

• Select a surgery type from the Applied Filter
  drop down
• Samples are created per surgery type
• You can elect to continue to do 100 of SIP and
  sample only those with a surgery type of Major
  Surgery
• Click Create Sample
• Confirm that all records all available
• All imports have to be done
• Records in yellow and marked Sample are to be
  done
• Surgeries that are not sampled
• Do all records
• We send to JCAHO and CMS those marked for
  sampling and all records from surgeries not
  sampled at all
• Want to see an example Click HERE

25
Core Options Software Changes

• Provide an APU SCIP
• Go to the facility settings area and remove all
  SIP measures
• Add back in as APU SCIP
• Custom Questions need to be added back to the APU
  measure
• Allow for record view of letter assignments with
  the abstract module
• Select record and it will display the letter
  assignments for each indicator
• For SCIP it will let you know if the patient had
  a principal diagnosis code of infection or was a
  burn or transplant patient
• Critical Access Changes
• Transfer pneumonia patients will now include only
  ER patients with a discharge status indicating
  transfer similar to the ER Measure
• Sampling allowed for the ER measure following the
  pregnancy sampling requirements

26
QUESTIONS

• Teresa Osieczonek
• E-mail tosieczonek_at_mha.org
• Phone [phone]

Laurie Morris E-mail lmorris_at_mha.org Phone
[phone]