MEASURE DESCRIPTION:
Percentage of patients aged 18 years or older, who undergo an elective procedure requiring anesthesia services who are screened for obstructive sleep apnea (OSA) AND, if positive, for whom two or more selected mitigation strategies were used prior to PACU discharge.
NQS DOMAIN/MEANINGFUL MEASURES AREA:
Patient Safety/Preventable Healthcare Harm
MEASURE TYPE:
Process
HIGH PRIORITY STATUS:
Yes
INVERSE MEASURE:
No
RISK ADJUSTED:
No
INSTRUCTIONS:
This measure is to be reported each time a patient undergoes an elective procedure under anesthesia during the reporting period. 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.
DENOMINATOR:
All patients aged 18 years or older, who undergo an elective procedure requiring anesthesia services.
Denominator Note: For the purposes of this measure, anesthesia services only include cases using general anesthesia, neuraxial anesthesia and monitored anesthesia care (MAC).
- Denominator Criteria (Eligible Cases):
Patient aged 18 years and older
AND
Elective procedure: G9643
AND
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
- Denominator Exclusions:
None
NUMERATOR:
Patients who are screened for obstructive sleep apnea AND, if positive, have documentation that two or more of the following mitigation strategies were used prior to PACU discharge:
- Preoperative initiation of continuous positive airway pressure (CPAP) or non-invasive positive pressure ventilation (NIPPV)
- Preoperative use of mandibular advancement devices or oral appliances
- Intraoperative administration of CPAP, nasopharyngeal airway, or oral appliance during sedation
- Use of major conduction anesthesia (spinal/epidural) or peripheral nerve block
- Multimodal analgesia
- Extubation while patient is awake
- Verification of full reversal of neuromuscular block
- Extubation and recovery carried out in lateral, semiupright, or other nonsupine position
- Postoperative administration of CPAP, nasopharyngeal airway, or oral appliance in the
postanesthesia care unit (PACU)
Numerator Options:
Performance Met: Positive patient screen for OSA OR existing OSA diagnosis AND documentation of two or more mitigation strategies used prior to PACU discharge (11A26)
OR
Performance Met: Negative patient screen for OSA (11A27)
OR
Performance Not Met: No patient screen for OSA OR positive OSA screen result and Documentation of less than 2 mitigation strategies used prior to PACU discharge (11A28)
OR
Denominator Exception: Documentation of medical reason(s) for not screening for obstructive sleep apnea and/or documenting the use of two or more mitigation strategies (e.g., patient remains intubated postoperatively, listed mitigation strategies contraindicated, other medical reason(s)) (11A38)
RELEVANT FIELDS:
- Date of service
- Date of birth
- ASA CPT code
- Elective case
- Primary type of anesthesia
- Existing OSA diagnosis
- OSA screening results
- ≥2 OSA mitigation strategies used
RATIONALE:
Undiagnosed OSA may pose a variety of problems for anesthesiologists and qualified anesthesia providers. A number of case reports have documented an increase in the incidence of postoperative complications and deaths among patients suspected of having OSA. Untreated OSA patients are known to have a higher incidence of difficult intubation, postoperative complications, increased intensive care unit admissions, and greater duration of hospital stay. Identifying patients with OSA is the first step in preventing postoperative complications due to OSA. Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality, incident stroke, and cancer incidence and mortality in this community- based sample. With improved preoperative assessment of OSA risk, anesthesiologists are better able to tailor their care to the individual patient’s needs through a variety of techniques and mitigation strategies.
REPORTING CODES: