Best Practices - AMI
Since 1989, the Agency for Healthcare Research
and Quality (AHRQ) has supported over 200 studies on treatments
for problems related to heart attack (also called acute myocardial
infarction or AMI). Findings from AHRQ-funded research have
led to changes by practitioners and other health system leaders
in all aspects of care for patients with chest pain, confirmed
heart attacks, and coronary artery disease.
The Centers for Medicare & Medicaid Service (CMS) and
the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) together developed core measures to be used to increase
the quality of care for AMI patients. The measures related
to treatment for AMI are:
- Aspirin within 24-hours of arrival
- Beta-blocker within 24-hours of arrival
- Thrombolytics within 30-minutes of arrival
- PCI within 120-minutes of arrival
- Prescription for aspirin at discharge
- Prescription for beta blocker at discharge
- Prescription for ACEI at discharge
- Prescription for a lipid-lowering
agent at discharge if LDL-C > 130 md/dl
- Documentation of smoking cessation counseling
or advice
The definition of and rationale for the selection of these measures is found in the document "Current Specification Manual for National Hospital Quality Measures," which can be found on the Joint Commission's website: http://www.jointcommission.org/PerformanceMeasurement/
PerformanceMeasurement/Current+NHQM+Manual.htm
Practitioners should stay up-to-date on
the current care practices to ensure they provide the best
care for their patients. The following example documents
were created to assist practitioners to provide adequate
care:
- The University of Michigan’s
Cardiovascular Center provides a pocket guide for the
Management of Acute Myocardial Infarction. This document
provides an AMI evaluation process chart, recommended
medicine dosages, and suggested non-medicinal care. Find
this document at: http://www.med.umich.edu/cvc/images/pdf/ami.pdf
- Health Care Excel developed a template that can be copied
onto Avery press-apply stickers (#5168) and placed in the
patient chart to help monitor appropriate AMI care. Find
the template file at: http://www.hce.org/Medicare/PDF_Documents/AMI_stickers.pdf
Practitioners can assist patients with
understanding disease and the procedures and care for AMI.
A variety of media are available including:
This website provides details about the performance for all Maryland
Hospitals for six of the nine measures identified previously
on this page. You should become familiar with this performance
information to be able to answer questions from your patients
regarding Hospital performance and the AMI core measure set. |
