– PERFORMANCE MEASURES –
Premier, Inc.

Premier Inc. is a nationwide organization of not-for-profit hospitals. The Premier/CMS Hospital Quality Incentive demonstration project is a program that combines reporting of quality performance measures with Pay for Performance (P4P).

The CMS/Premier Pay-for-Performance Demonstration (or Hospital Quality Incentive Demonstration) is a national pay-for-performance project that is designed to determine if financial incentives are effective at improving the quality of inpatient hospital care. The three-year project of 260 voluntarily participating hospitals officially started on October 30, 2003, under the management of the Centers for Medicare and Medicaid Services (CMS) and Premier Inc. Tracking of hospitals’ performance is achieved by Premier's proprietary Perspective™ database and is reported to CMS.

The 2006 list of performance measures and their technical specifications reveal 34 performance measures addressing 5 domains of hospital care:

Premier/CMS – 5 Clinical Domains of
Health Quality Incentive Demonstration Project

Domain		Measures
•	Acute Myocardial Infarction (AMI)	9
•	Coronary artery bypass graft (CABG)	8
•	Heart failure (HF)	4
•	Community-acquired pneumonia (CAP)	7
•	Hip and knee replacement	6

The 34 measures include all 21 of the Hospital Care Measures utilized in the 2005 reporting to HQA/CMS's Hospital Compare. In addition, the Demonstration project has included 4 performance measures from AHRQ's 27 Patient Safety Indicators (PSI), plus measures from The Leapfrog Group, and governmental organizations. The complete list of performance measures in 2006 are provided below.

Premier/CMS – 34 Performance Measures of
Health Quality Incentive Demonstration Project
Adapted from Premier 2006 Measure Specifications [PDF]

	Identifiers		Source	Measures
	NQF	Other
Acute Myocardial Infarction (AMI)
1.	HC1	–	CMS-QIOs JCAHO	Aspirin at Arrival:   AMI patients who received aspirin within 24 hours before or after hospital arrival
2.	HC2	–	CMS-QIOs JCAHO	Aspirin prescribed at discharge:   AMI patients who are prescribed aspirin at hospital discharge
3.	HC6	–	CMS-QIOs JCAHO	ACE-I or ARB for LVSD:   AMI patients with LVSD who are prescribed an ACE-I or ARB at hospital discharge
4.	HC33	–	CMS-QIOs JCAHO	Adult smoking cessation advice counseling:   AMI patients (cigarette smokers) who receive smoking cessation advice or counseling during hospital stay
5.	HC4	–	CMS-QIOs JCAHO	Beta Blocker prescribed at discharge:   AMI patients who are prescribed a beta blocker at hospital discharge
6.	HC3	–	CMS-QIOs JCAHO	Beta Blocker at arrival:   AMI patients who received a beta blocker within 24 hours after hospital arrival
7.	HC8	–	CMS-QIOs	Thrombolytic Agent received within 30 minutes of hospital arrival:   AMI patients whose time from hospital arrival to thrombolysis is 30 minutes or less
8.	HC7	–	CMS-QIOs	Percutaneous Coronary Intervention (PCI) received within 120 minutes of hospital arrival:   AMI patients whose time from hospital arrival to Percutaneous Coronary Intervention (PCI) is 120 minutes or less
9.	HC5	–	JCAHO	Inpatient Mortality:   Inpatient mortality of AMI patients
Coronary Artery Bypass Graft Surgery (CABG)
10.	–1	–	LFG	Aspirin prescribed at discharge:   Isolated CABG patients who are prescribed aspirin at hospital discharge
11.	HC11	–	JCAHO	CABG using internal mammary artery (IMA):   Isolated CABG patients who receive IMA graft (ICD-9-CM procedure codes 36.15, 36.16)
12.	CS3	–	JCAHO	Prophylactic antibiotic timing:   Isolated CABG patients who received prophylactic antibiotics within 1 hour prior to surgical incision (2 hours if receiving vancomycin or a fluoroquinolone)
13.	CS4	–	JCAHO	Prophylactic antibiotic selection:   Isolated CABG patients who received prophylactic antibiotics recommended for their specific surgical procedure.
14.	CS6	–	JCAHO	Prophylactic antibiotics duration:   Isolated CABG patients whose prophylactic antibiotics were discontinued within 48 hours after surgery end time.
15.	–	–	–	CABG Mortality:   Inpatient mortality of isolated CABG patients with risk-adjustment according to 3M™ APR-DRG
16.	–	–	AHRQ PSI	Post operative hemorrhage or hematoma:   Isolated CABG patients with ICD-9-CM codes for postoperative hemorrhage or postoperative hematoma in any secondary diagnosis field and code for postoperative control of hemorrhage or drainage of hematoma (respectively) in any secondary procedure code; Procedure code for postoperative control of hemorrhage or hematoma must occur on the same day or after the ICD-9-CM Principal procedure day.
17.	–	–	AHRQ PSI	Post operative physiologic and metabolic derangement:   Discharges with ICD-9-CM codes for physiologic and metabolic derangements in any secondary diagnosis field. Discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by a procedure code for dialysis (39.95, 54.98)
Heart Failure (HF)
18.	HC13	–	CMS-QIOs JCAHO	Left ventricular function (LVF) assessment:   Heart failure patients with documentation in the hospital record that LVF was assessed before arrival, during hospitalization, or is planned for after discharge
19.	HC14	–	CMS-QIOs JCAHO	Discharge Instructions:   Heart failure patients with documentation that they or their caregivers were given written discharge instructions or other educational material addressing all of the following: 1. activity level, 2. diet, 3. discharge medications, 4. follow-up appointment, 5. weight monitoring, 6. what to do if symptoms worsen
20.	HC15	–	CMS-QIOs JCAHO	ACE-I or ARB for LVSD:   Heart failure patients who are prescribed ACE-I or ARB at hospital discharge
21.	HC34	–	CMS-QIOs JCAHO	Adult smoking cessation advice counseling:   Heart Failure patients (cigarette smokers) who receive smoking cessation advice or counseling during the hospital stay
Community-acquired pneumonia (CAP)
22.	HC23	–	CMS-QIOs JCAHO	Oxygen Assessment:   Pneumonia patients whose arterial oxygenation was assessed by arterial blood gas (ABG) or pulse oximetry within 24 hours prior to or after hospital arrival
23.	HC24	–	CMS-QIOs JCAHO	Antibiotic selection:   Immunocompetent patients with Community-Acquired Pneumonia who received an initial antibiotic regimen during the first 24 hours consistent with current guidelines
23a.	HC24	–	CMS-QIOs JCAHO	Antibiotic selection in ICU:   Immunocompetent ICU patients with Community-Acquired Pneumonia who received an initial antibiotic regimen during the first 24 hours consistent with current guidelines
23b.	HC24	–	CMS-QIOs JCAHO	Antibiotic selection in non-ICU:   Immunocompetent non-ICU patients with Community-Acquired Pneumonia who received an initial antibiotic regimen during the first 24 hours consistent with current guidelines
24.	HC25	–	CMS-QIOs JCAHO	Blood Cultures in ER:   Number of pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics
25.	HC26	–	CMS-QIOs JCAHO	Influenza Vaccine:   Patients discharged during October, November, December, January, or February with pneumonia, age 50 and older, who were screened for influenza vaccine status and were vaccinated prior to discharge, if indicated.
26.	HC27	–	CMS-QIOs JCAHO	Pneumococcal Vaccine:   Patients with pneumonia, age 65 and older who were screened for pneumococcal vaccine status and were vaccinated prior to discharge, if indicated.
27.	HC28	–	CMS-QIOs JCAHO	Antibiotic Timing:   Pneumonia patients who received their first dose of antibiotics within 4 hours after arrival at the hospital
28.	HC35	–	CMS-QIOs JCAHO	Adult smoking cessation advice counseling:   Pneumonia patients (cigarette smokers) who receive smoking cessation advice or counseling during the hospital stay
Hip and Knee Replacement
29.	HC36	–	CMS-QIOs	Antibiotic Timing:   Hip or Knee Replacement patients who received prophylactic antibiotics within 1 hour prior to surgical incision (2 hours if receiving vancomycin or a fluoroquinolone)
30.	HC37	–	CMS-QIOs	Antibiotic Selection:   Hip or Knee Replacement patients who received prophylactic antibiotics recommended for their specific surgical procedure
31.	HC38	–	CMS-QIOs	Antibiotic Duration:   Hip or knee replacement patients whose prophylactic antibiotics were discontinued within 24 hours after surgery end time.
32.	–	–	AHRQ PSI	Post operative hemorrhage or hematoma:   Hip or knee replacement patients with ICD-9-CM codes for postoperative hemorrhage or postoperative hematoma in any secondary diagnosis field and code for postoperative control of hemorrhage or drainage of hematoma (respectively) in any secondary procedure code; Procedure code for postoperative control of hemorrhage or hematoma must occur on the same day or after the ICD-9-CM Principal procedure day.
33.	–	–	AHRQ PSI	Post operative physiologic and metabolic derangement:   Hip or knee replacement patients with ICD-9-CM codes for physiologic and metabolic derangements in any secondary diagnosis field. Discharges with acute renal failure (subgroup of physiologic and metabolic derangements) must be accompanied by a procedure code for dialysis (39.95, 54.98)
34.	–	–	Premier	Readmissions 30 days post discharge:   Hip or knee replacement patients readmitted to any acute care hospital within 30 days of discharge (Readmission source = MedPAR data).
1	The NQF endorsed a simlar STS measure (#CS12) in 2004 as 1 of the 21 measures in the National Voluntary Consensus Standards for Cardiac Surgery. The Leapfrog Group (LFG) and STS measures are similar but have different numerators and exclusionary criteria.