AQI 48: Patient-Reported Experience with Anesthesia

MEASURE DESCRIPTION:

Percentage of patients aged 18 and older, who were surveyed on their patient experience and satisfaction with anesthesia care and who reported a positive experience.

This measure will consist of two performance rates:

**AQI48a: Percentage of patients, aged 18 and older, who were surveyed on their patient experience and satisfaction with anesthesia care

**AQI48b: Percentage of patients, aged 18 and older, who completed a survey on their patient experience and satisfaction with anesthesia care and who report a positive experience with anesthesia care

NOTE: The measure requires that a valid survey, as defined in the numerator of 48a, be sent to patients between discharge from the facility and within 30 days of facility discharge. To report AQI 48b, a minimum number of 20 surveys, as described in the numerator of 48a, with the mandatory question completed must be reported. In order to be scored on this measure, clinicians must report BOTH AQI48a AND AQI48b.

NQS DOMAIN/MEANINGFUL MEASURES AREA:
Person and Caregiver-Centered Experience and Outcomes / Patient’s Experience of Care

MEASURE TYPE:
Patient-Reported Outcome

HIGH PRIORITY STATUS:
Yes

INVERSE MEASURE:
No

RISK ADJUSTED:
No

INSTRUCTIONS:

This measure consists of two performance rates: AQI48a and AQI48b. AQI48a should be reported each time a patient undergoes a procedure under anesthesia. AQI48b should be reported every time a completed survey is returned by the patient. To be scored on AQI48b, the provider must collect the individual scores received on the survey as described in AQI48a. It is anticipated that qualified anesthesia providers and eligible clinicians who provide denominator-eligible services will submit this measure.

Measure Reporting via the Qualified Clinical Data Registry

Patient demographics and CPT codes are used to identify patients who are included in the measure denominator. G-codes and Registry Codes are used to capture the numerator.

RATIONALE:

Despite the implementation of CAHPS and H-CAHPS, there is a persistent gap in the ability to adequately measure patient experience on the selection of performance measures for performance-based payment programs. To provide high quality, patient-centered care in the future, anesthesiologists and other qualified anesthesia providers should measure and respond to the patients’ perception of the degree to which they felt they were treated as individuals and empowered by their anesthesiology practitioners to engage in decision-making for their care. The assessment of patient satisfaction with anesthesia care provides important feedback which enables providers to improve care delivery and quality. At present there is a vast array of tools available for practices and individuals to implement based upon local patient populations and for local quality improvement initiatives.

OVERALL PERFORMANCE RATE FOR SCORING:

AQI48b

**AQI 48a**

MEASURE DESCRIPTION-AQI48a:

Percentage of patients, aged 18 and older, who were surveyed on their patient experience and satisfaction with anesthesia care.

DENOMINATOR-AQI48a: 

Patients aged 18 and older, who undergo a procedure* under anesthesia 

Definition: *Any procedure including surgical, therapeutic or diagnostic

• Denominator Criteria (Eligible Cases):

  Patient aged 18 years or older on date of encounter

  AND
  

  AQI 48a: Patient encounter during the reporting period (CPT): 

  00100, 00102, 00103, 00104, 00120, 00124, 00126, 00140, 00142, 00144, 00145, 00147, 00148, 00160, 00162, 00164, 00170, 00172, 00174, 00176, 00190, 00192, 00210, 00211, 00212, 00214, 00215, 00216, 00218, 00220, 00222, 00300, 00320, 00322, 00350, 00352, 00400, 00402, 00404, 00406, 00410, 00450, 00454, 00470, 00472, 00474, 00500, 00520, 00522, 00524, 00528, 00529, 00530, 00532, 00534, 00537, 00539, 00540, 00541, 00542, 00546, 00548, 00550, 00560, 00562, 00563, 00566, 00567, 00580, 00600, 00604, 00620, 00625, 00626, 00630, 00632, 00635, 00640, 00670, 00700, 00702, 00730, 00731, 00732, 00750, 00752, 00754, 00756, 00770, 00790, 00792, 00794, 00796, 00797, 00800, 00802, 00811, 00812, 00813, 00820, 00830, 00832, 00840, 00842, 00844, 00846, 00848, 00851, 00860, 00862, 00864, 00865, 00866, 00868, 00870, 00872, 00873, 00880, 00882, 00902, 00904, 00906, 00908, 00910, 00912, 00914, 00916, 00918, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938, 00940, 00942, 00944, 00948, 00950, 00952, 01112, 01120, 01130, 01140, 01150, 01160, 01170, 01173, 01200, 01202, 01210, 01212, 01214, 01215, 01220, 01230, 01232, 01234, 01250, 01260, 01270, 01272, 01274, 01320, 01340, 01360, 01380, 01382, 01390, 01392, 01400, 01402, 01404, 01420, 01430, 01432, 01440, 01442, 01444, 01462, 01464, 01470, 01472, 01474, 01480, 01482, 01484, 01486, 01490, 01500, 01502, 01520, 01522, 01610, 01620, 01622, 01630, 01634, 01636, 01638, 01650, 01652, 01654, 01656, 01670, 01680, 01710, 01712, 01714, 01716, 01730, 01732, 01740, 01742, 01744, 01756, 01758, 01760, 01770, 01772, 01780, 01782, 01810, 01820, 01829, 01830, 01832, 01840, 01842, 01844, 01850, 01852, 01860, 01916, 01920, 01922, 01924, 01925, 01926, 01930, 01931, 01932, 01933, 01935, 01936, 01951, 01952, 01958, 01960, 01961, 01962, 01963, 01965, 01966, 01967, 01991, 01992, 20526, 20550, 20551, 20552, 20553, 20600, 20604, 20605, 20606, 20610, 20611, 27096, 36555, 36556, 36570, 36571, 36578, 36580, 36581, 36582, 36583, 36584, 36585, 62263, 62264, 62270, 62272, 62273, 62280, 62281, 62282, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62328, 62329, 62350, 62355, 62360, 62361, 62362, 62365, 62370, 63650, 63661, 63662, 63663, 63664, 63685, 63688, 64400, 64405, 64408, 64415, 64416, 64417, 64418, 64420, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64454, 64461, 64463, 64479, 64483, 64486, 64487, 64488, 64489, 64490, 64493, 64505, 64510, 64517, 64520, 64530, 64600, 64605, 64610, 64620, 64624, 64625, 64630, 64633, 64635, 64640, 64680, 64681, 72275, 93503, 95990, 95991

• Denominator Exclusions-AQI48a:

  Organ Donors as designated with ASA Physical Status 6

  OR

  Patient died within 30 days of the procedure (10A11) 

NUMERATOR-AQI48a:

Patients who received a survey within 30 days of the procedure to assess their experience and satisfaction with anesthesia.

Numerator Note: The survey should be administered to the patient shortly following discharge from the facility.

Definition: Practices and eligible clinicians may customize their patient experience and satisfaction with anesthesia surveys to meet local needs but, at a minimum, a valid survey must include a core set of questions that address three of the four following criteria related to patient experience and satisfaction and one mandatory question described below.

1. Pre-operative Education and Preparation
2. Patient and/or Family Communication
3. Care Team Response to Comfort and Well-Being
4. Post-operative pain control and/or management

Mandatory question that must be included in each valid survey (practices must also include an option for patient to indicate “Not Applicable”):

"On a scale of 1 to 5, where 1 indicates the worst anesthesia experience and where 5 indicates the best anesthesia experience, how would you rate your anesthesia experience?"

Numerator Note: Practices and eligible clinicians may wish to supplement these questions by taking into consideration the recommendations of the ASA Committee on Performance and Outcomes Measurement work product entitled “Patient Satisfaction with Anesthesia White Paper.”

Numerator Note: Depending on local practice, practices and eligible clinicians may wish to supplement survey questions by taking into consideration the recommendations developed as part of the Perioperative Surgical Home (PSH) that are structured in five distinct components.

1. Pre-Operative Education and Preparation (Four Indicators)

• Patient comfort with instructions provided about eating better

• Patient comfort with instructions provided about exercise or physical therapy

• Patient comfort with instructions provided about stopping smoking (if applicable)

• Patient comfort with instructions provided about what to do after surgery

2. Check-In and Pre-Procedure Experience

3. Caregiver and Family Communication during Surgery

4. Care Team Response to Comfort and Well-Being

5. Post-Operative Pain Management

For more information on these resources, visit https://www.asahq.org/psh.

Numerator Options-AQI48a:

• Performance Met: Patient provided with a survey within 30 days of the procedure to assess their experience and satisfaction with anesthesia (10A12)

  OR

  Performance Not Met: Patient was not provided with a survey within 30 days of the procedure to assess their experience and satisfaction with anesthesia (10A14)

  OR

  Denominator Exception: Documentation of patient reason(s), process reason(s)or medical reason(s) for not receiving survey (i.e. patients who are non-verbal, who are unable to be surveyed due to a medical or psychiatric reason, who are unable to be surveyed due to a language barrier, have not provided contact information who are discharged to assisted living, skilled nursing facility or other similar location where direct access to the patient is not available, or who decline to be surveyed. (10A13)

RELEVANT FIELDS:

• Date of Procedure

• Date of Birth

• ASA CPT Code

• ASA Physical Status

• Received a survey within 30 days

REPORTING CODES:

**AQI 48b**

MEASURE DESCRIPTION-AQI48b:

Percentage of patients who complete the survey from AQI48a on their patient experience and satisfaction with anesthesia care and report a positive experience.

DENOMINATOR-AQI48b: 

All patients from the numerator of AQI48a who complete a survey on their patient experience and satisfaction with anesthesia care

Denominator Note: In order to report AQI48b, the denominator must include a minimum of 20 returned surveys.

• Denominator Criteria (Eligible Cases):

  Patient completed a survey on their patient experience and satisfaction with anesthesia care: 10A72

• Denominator Exclusions-AQI48b:

  Patient did not complete the mandatory anesthesia satisfaction question: 10A69

NUMERATOR-AQI48b:

Patients who reported a positive experience with anesthesia care.

Definition: A positive experience is defined as a response of 4 or 5 on the following mandatory patient experience and satisfaction survey question (practices must include an option for patient to indicate “Not Applicable”):

"On a scale of 1 to 5, where 1 indicates the worst anesthesia experience and where 5 indicates the best anesthesia experience, how would you rate your anesthesia experience?" 

Numerator Options:

Numerator Note: To report this measure, the provider must report the individual patient scores. A percentage reporting a positive experience will be calculated on the provider’s behalf.

Performance Met: Patient reported a positive anesthesia experience (i.e., a 4 or 5 on the mandatory survey question) (10A70)

OR

Performance Not Met: Patient did NOT report a positive anesthesia experience (i.e., a 1, 2, or 3 on the mandatory survey question) (10A71)

RELEVANT FIELDS:

• Date of procedure
• Date of birth
• ASA CPT code
• ASA physical status
• Received a survey within 30 days
• Survey response received
• Survey response answer

REPORTING CODES: