1 Performance measure for AMI / ACS - Not a primary measure for CABG.
2 Definitions include varying numbers of exclusions / ‘contra-indications.’ NQF definitions have no exclusions whereas other definitions include exclusionary criteria.
3 Cholesterol Management in patients with cardiovasuclar conditions includes the percentage of CABG patients who had a low-density lipoprotein cholesterol (LDL-C) screening performed and the percentage of patients who have a documented LDL-C level less than 130 mg/dL and less than 100 mg/dL.
4 CABG mortalilty risk models vary. NQF Standards for Hospital Care uses NY State Cardiac Surgery Reporting System's logistic regression model, while NQF Standards for Cardiac Surgery uses the California CCORP model for inpatient mortality, and COAP (Washington State) uses its own risk model. Premier CMS uses 3M™ Risk adjusted - All Patient Refined DRG methodology. AHRQ IQI uses JCAHO APR-DRG risk-stratification methodology.
The Leapfrog Group assigns a quartile mortality performance based upon self-reported data from either the "Leapfrog Survey" or STS performance of ‘worse than national average’ or ‘better than national average.’ The risk-adjustment follows the appropriate Leapfrog-approved State statistical model (NY, NJ, PA, CA) or the STS model, (although Leapfrog does not stipulate whether hospitals use the STS inpatient or STS 30-day operative mortality standard for this self-reported information). Based on either source, this binary disposition accounts for 34% of the scoring per Leapfrog's methodology. Because of this adjustment, a hospital's placement in a Leapfrog quartile does not convey whether its risk-adjusted mortality rate is statistically significantly different from (a) the statewide average, or (b) another hospital in its quartile, or (c) another hospital in a different quartile.
5 New Jersey and Pennsylvania actually validate 30-day mortality in the state database, whereas all other mortality rates are self-reported by facility.
6 AHRQ and the NQF Cardiac Surgery measures use volume based on administrative data reports; COAP and The Leapfrog Group rely upon self-reported volumes.
7 The NQF Hospital Measures endorsed CABG-volume according to NY State definition.
* On June 16, 2006, the AQA Alliance adopted a subset of 15 of the NQF's 21 National Voluntary Consensus Standards for Cardiac Surgery as a "starter set" of performance measures [See Announcement – Word .Doc].