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Process Metrics
By Chad Whelan, MD & David Klocke, MD
Process metrics are probably the most useful metrics for assessing the success of your interventions in ACS. They are used to determine if the steps you believe will lead to better outcomes are being met. They could include categories such as:
- Use of forms or pathways. (Visit the Clinical Tools section for examples of order sets and care maps).
- Adherence to recommended prescribing patterns.
- Door to balloon time.
Most of the CMS core measures are in fact process measures. They are used because they are easier to measure, directly correlate with your efforts, and are probably more responsive to an intervention than outcome measures. It is important to know, though, that improving process measures is an intermediate step and does not assure improved outcome measures. You may want to think of most of these as 2-layer metrics. In the first pass, you would use all patients with ACS as your denominator. This would allow you to see the raw numbers of how many patients are receiving the quality measure. However, you may be more interested in knowing, not the percentage of all patients who got the measure, but rather the percentage of patients without a contraindication who got the measure. In this metric, the denominator would be smaller than the overall denominator.
- Percentage of patients receiving ASA — this is a core measure. If not given during the hospitalization, documentation should reflect the reason for not giving the medication.
- Percentage of patients receiving beta-blocker — this is a core measure. If not given during the hospitalization, documentation should reflect the reason for not giving the medication.
- Percentage of patients receiving ACE/ARB — indicated for blood pressure control and EF < 40%. Also indicated as a front-line BP medication for diabetics if tolerant with beta-blockers.
- Percentage of patients receiving statin — standard of care for all ACS patients.
- Percentage of patients receiving dietary consultation — standard of care for all ACS patients.
- Percentage of smokers receiving smoking cessation instructions — standard of care for all ACS patients.
- Percentage of delayed reporting of high-risk abnormal labs — patient safety issue. This is measured in order to seek out opportunities for process improvement.
- Percentage of patients receiving cardiac risk assessment — standard of care for all ACS patients.
- Percentage of patients with LVEF recorded on dismissal — important to recognize patients with EF< 40% in order to initiate therapy against remodeling of the left ventricle.
- Compliance with documentation of communication with primary care physician (PCP) — patient safety issue. This is measured in order to seek out opportunities for process improvement.
- Compliance with medication reconciliation — patient safety issue. This is measured in order to seek out opportunities for process improvement. Joint Commission standard.
- Percentage of appointments with PCP within 1 week — patient safety issue. This is measured in order to seek out opportunities for process improvement.
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ACS Resource Room Project Team
This resource room is supported in part by an educational grant from the Bristol-Myers Squibb / Sanofi Pharmaceuticals Partnership.
Disclaimer
The Acute Coronary Syndrome (ACS) Resource Room is an online resource for visitors to the Society of Hospital Medicine's website. All content and links have been reviewed by Acute Coronary Syndrome Resource Room Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.
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