Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <= 40% who were prescribed beta-blocker therapy. There are two performance rates and clinicians can choose to report on one or the other.
- Percentage of patients with a diagnosis of CAD or history of cardiac surgery who have a current or prior LVEF <= 40% who were prescribed beta-blocker therapy
- Percentage of patients with a diagnosis of CAD or history of cardiac surgery who have a prior (within the past 3 years) myocardial infarction who were prescribed beta-blocker therapy
Numerator #1 & #2
Patients who were prescribed beta-blocker therapy. This can be completed in two ways:
- Script Writer: Provider prescribes beta-blocker therapy through the Amazing Charts Script Writer
- Current Medications: The patient has a beta-blocker therapy medication listed in their current meds list.
- Note: The provider does not have to be the prescribing provider to get credit.
Denominator #1
Patients ages 18 and up will be added to the denominator if they meet all the following criteria:
- Two encounters during the measurement period (One of these encounters will be used to evaluate the numerator.)
- Has Left Ventricular Ejection Fraction (LVEF) equal to or under 40%, recorded in the Review of Systems, Physical Exam, or Assessment. Any of the following phrases will qualify
- 'LVEF = 40' or 'LVEF 40' (or any other number between 0 and 40)
- 'EF = 40' or 'EF 40' (or any other number between 0 and 40)
- 'Ejection Fraction = 40' or 'Ejection Fraction 40' (or any other number between 0 and 40)
- 'Left Ventricular Ejection Fraction = 40' or 'Left Ventricular Ejection Fraction 40' (or any other number between 0 and 40)
- 'Left Ventricular Ejection Fraction <= 40' or 'LVEF <= 40' or 'EF <= 40' or 'Ejection Fraction <= 40'
- Diagnosis or Surgery: The patient must meet one of the criteria below (diagnosis or procedure) for this criteria to be counted:
- Coronary Artery Disease recorded during one of the encounters used to qualify for the denominator (which will be the same encounter used to calculate the numerator): using an appropriate diagnosis code.
- History of Cardiac Surgery identified with an appropriate CPT assigned to the encounter.
- History of Cardiac Surgery identified by text in the Past Medical History field of a patient encounter. The text can contain any of the following phrases:
- Coronary artery bypass graft
- CABG
- PTCA
- History of Cardiac Surgery identified by an appropriate diagnosis assigned to the patients problem list
Denominator #2
Patients ages 18 and up will be added to the denominator if they meet all the criteria: #1, #2 and one of the items from #3
- Two encounters during the measurement period identified by an appropriate CPT codes: .(One of these encounters will be used to evaluate the numerator.)
- Diagnosis of myocardial infarction (within the last 3 years) using an appropriate diagnosis code
- Diagnosis or Surgery: The patient meets at least one of the criteria below:
- Coronary Artery Disease recorded during one of the encounters used to qualify for the denominator (which will be the same encounter used to calculate the numerator), using an appropriate ICD-10 code
- History of Cardiac Surgery identified with an appropriate CPT in a superbill
- History of Cardiac Surgery identified by text in the Past Medical History field of a patient encounter. The text can contain any of the following phrases:
- Coronary artery bypass graft
- CABG
- PTCA
- History of Cardiac Surgery identified by an appropriate diagnosis assigned to the patients problem list
Denominator Exceptions
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., arrhythmia, asthma, bradycardia, hypotension, patients with atrioventricular block without cardiac pacer, observation of consecutive heart rates < 50, allergy, intolerance, other medical reasons):
- DX of Arrhythmia, Hypotension, Asthma, or Bradycardia in patient's problem list
- allergy to beta blockers listed in the allergy section of the chart.
- Free Text in the Plan or Assessment either:
- "Patient not prescribed beta blocker"
- "intolerance to beta blocker"
- Documentation of patient reason(s) for not prescribing beta-blocker therapy: Free Text "Patient Declines Beta Blocker" in Assessment or Plan