Appendix 1. DEFINITIONS AND EXPLANATIONS

Transcription

1 Appendix 1. DEFINITIONS AND EXPLANATIONS Study Proportion of active eligible patients in your practice that have achieved the criteria that meet the guideline measure. Active diagnosis A diagnosis is considered active if it has been recorded either on a problem list, or diagnosis list and not designated with inactive status or a resolved date. Active prescription A prescription is considered active if it lacks a discontinuation date. Adult patient Benchmark Median National Subgroup sizes SQUID A patient who is 18 years old or older Line indicating achievable benchmark of care (ABC )* of 90th percentile of all PPRNet practices. Typically recalculated each January. Line indicating 50th percentile of all PPRNet practices (recalculated each January). Line indicating published national data for the specific measure (where available). Represents the minimum and maximum number of eligible patients each month over time. Summary Quality Indicator reflects the average proportion of quality processes and outcomes that are up-to-date and under control in your practice. The SQUID score for each patient is calculated by dividing the number of measures each patient has met by the number of measures for which he/she is eligible. For example, a 46 year old woman with no chronic disease is eligible for 9 processes (BP monitoring, total cholesterol, HDL, Pap smear, Td vaccine, Flu vaccine; depression, alcohol, and smoking screening) and 0 outcome measures. If she is up-to-date with these four measures: BP monitoring, Pap Smear, Td and flu vaccine, but not the other 5 measures, her SQUID=4/9=0.44. The mean SQUID score across all the patients in your practice is the practice SQUID and can be tracked over time to help quantify overall practice improvement in quality performance indicators. EHR VENDOR-SPECIFIC DEFINITIONS: Mckesson (Practice Partner, Lytec and Medisoft): Active patient A patient is defined as active if he/she has had a visit within 1 year. CCDA files are generated on all patients regardless of patient status. All deceased and inactive patients will drop off your report after 1 year. To remove inactive patients immediately, please assign a usual provider name of INACTIVE, INACTIVE with corresponding provider code of INA, or for deceased patients, please assign a usual provider name of DECEASED, DECEASED with corresponding provider code of DEC. Alternatively, you can use any of the following codes to remove deceased patients: Coding System Code Code Description SNOMEDCT Patient deceased during stay (discharge status = dead) (finding) SNOMEDCT Patient status determination, deceased (finding) SNOMEDCT Patient discharge, deceased, medicolegal case (procedure) SNOMEDCT Patient discharge, deceased, autopsy (procedure) SNOMEDCT Patient deceased during stay (discharge status = dead) (finding)

2 SNOMEDCT Patient discharge, deceased, donation of body (procedure) SNOMEDCT Patient discharge, deceased, no autopsy (procedure) SNOMEDCT Patient discharge, deceased, to anatomic board (procedure) ICD DEATH, INSTANTANEOUS ICD10 R99 Ill-defined and unknown cause of mortality ICD DEATH, LESS THAN 24 HRS ONSET SYMP ICD DEATH, UNATTENDED Active diagnosis Lab results A diagnosis is considered active if it has been recorded either on a problem list, or diagnosis list and not designated with inactive status or a resolved date. Lab results are located in the laboratory tables, not in the Lab Miscellaneous section MD Suite Active patient Active diagnosis A patient is defined as active if he/she has had a visit within 1 year. *DETAILS COMING SOON Lab results *DETAILS COMING SOON EPIC Active patient Active diagnosis A patient is defined as active if he/she has had a visit within 1 year. *DETAILS COMING SOON Lab results *DETAILS COMING SOON

3 Diabetes Mellitus Practice Guideline Study Screening for Type 2 Diabetes Mellitus Eligible Patients Patients ages 40 to 70 with BMI >25 and without active dx of Diabetes Mellitus Criteria that meets Glucose test or HbA1c lab result recorded in previous 3 years Mckesson (Practice Partner, Lytec and Medisoft) Laboratory Results MD Suite *DETAILS COMING SOON EPIC *DETAILS COMING SOON Diabetes Mellitus: High blood pressure control Diabetes Mellitus: Hemoglobin A1c control (< 7%) Patients years of age with an active DX of Diabetes Mellitus and a BP recorded in vital signs in previous 6 months Patients years of age with an active DX of Diabetes Mellitus Most recent systolic BP <140 and diastolic < 90 in previous year Most recent HgbA1c lab result in previous year is < 7% Vital Signs Laboratory Results Diabetes Mellitus: Hemoglobin A1c control (< 8%) Patients years of age with an active DX of Diabetes Mellitus Most recent HgbA1c lab result in previous year is < 8% Laboratory Results Diabetes Mellitus: Hemoglobin A1c poor control (<= 9%) Patients years of age with an active DX of Diabetes Mellitus Most recent HgbA1c lab result in previous year is < 9% Laboratory Results Nephropathy Assessment Patients years of age with an active DX of Diabetes Mellitus Active Rx for ACE-I or ARB -OR- active Dx of CKD -OR- have had a urinary microalbumin Dx- Problem List and/or Diagnoses Rx- Medication List

4 Diabetes Mellitus: Foot exam Diabetes Mellitus: Dilated eye exam Patients years of age with an active DX of Diabetes Mellitus Patients years of age with an active DX of Diabetes Mellitus lab result recorded in previous year A diabetic foot exam recorded in previous year A dilated eye exam recorded in previous year Lab- Laboratory Results Procedures Procedures Cardiovascular Disease Practice Guideline Study Screening for high blood pressure All adult patients Eligible Patients Criteria that meets A BP recorded in previous 2 years Vital Signs Patients diagnosed with HTN for 3 BP measures 140/90 in past year Adults with 3 BP measures 140/90 in past year Active DX of Hypertension Problem List and/or Diagnoses Controlling high blood pressure (BP) Cholesterol Abnormalities screening and HDL-C screening Patients years of age with active DX of Hypertension Patients years old BP measured in past year and most recent BP <140/90 A Total cholesterol lab result and an HDLcholesterol lab result recorded in previous 5 years Vital Signs Laboratory Results ^^^Concordance with ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction Patients 21 years old and older ^^^Concordance in patients current statin therapy with the AHA/ACC statin therapy guidelines

5 Ischemic Vascular Disease: Use of aspirin or another antithrombotic High Risk patients with current anti-platelet Rx Patients with atrial fibrillation with current anti-platelet or oral anticoagulant Rx Adult patients with active DX of Ischemic Vascular Disease Adults with active DX of Ischemic Vascular Disease OR Men ages years old with active DX of tobacco abuse, hyperlipidemia, or hypertension Adults with active DX of Atrial Fibrillation A current prescription for an antiplatelet or anticoagulant medication A current prescription for an anti-platelet medication A current prescription recorded for an anticoagulant or antiplatelet Heart Failure (HF): ACE inhibitor or ARB Therapy Heart Failure (HF): Beta blocker Therapy Patients screened for abdominal aortic aneurysm Adults with active DX of Systolic Heart Failure, Congestive Heart Failure, or Heart Failure NOS Adults with active DX of Systolic Heart Failure, Congestive Heart Failure, or Heart Failure NOS Men ages years old with any Tobacco related DX or positive Tobacco Use recorded in Vital Signs. Includes Tobacco Abuse, Past Tobacco Abuse, & Smoking Counseling A current prescription recorded for an ACE Inhibitor or Angiotensin receptor blocker medication A current prescription recorded for a Beta Blocker medication Screening for AAA recorded once since 65th birthday Problem List, Diagnoses, and/or Procedures Chronic Kidney Disease Practice Guideline Study Urine albumin to creatinine ratio in past year for pts at risk for CKD (DM and/or HTN) Eligible Patients Adults with active dx of DM and/or active dx of HTN (excluding patients meeting criteria for CKD) Criteria that meets Test for albuminuria or urine protein (spot albumin to creatinine, albumin specific

6 ^^Urine albumin to creatinine ratio in past year for pts with CKD ^^egfr in past 6 months in patients with Stage 3A or 4 CKD Hemoglobin measured annually for all patients meeting criteria for Stage 3b-5 CKD Most recent BP < 130/80 mmhg in past year for pts with CKD and Albumin to Cr ratio > 300 Rx for ACEI or ARB in past year for pts with CKD and HTN and Albumin to Cr ratio > 300 Quantitative urine albumin in past year for pts with CKD (excluding pts with albumin to cr ratio > 300) Adults with calculated stage 3A or 4 CKD (egfr 30-60) by MDRD equation Adults with Stage 3B-5 CKD (egfr<45) Adults meeting criteria for CKD and with severely increased albuminuria (albumin stage A3) or proteinuria: albumin to creatinine ratio >300mg/g or 300mg of albumin in the urine per 24 hours or urine protein to creatinine ratio > 0.3 mg/mg creatinine Adults with dx of HTN and meeting criteria for CKD with severely increased albuminuria (albumin stage A3) or proteinuria: albumin to creatinine ratio >300mg/g or 300mg of albumin in the urine per 24 hours or urine protein to creatinine ratio > 0.3 mg/mg creatinine dipstick, urine protein/creat ratio, 24 hr urine albumin, microalbumin ) in past 12 months Test for albuminuria or urine protein (spot albumin to creatinine, albumin specific dipstick, urine protein/creat ratio, 24 hr urine albumin, microalbumin ) in past 12 months egfr or serum Cr lab result recorded in past 6 months Hgb lab result recorded in past 12 months Most recent BP less than 130/80 Active Rx for ACEI or ARB Vital Signs

7 Women s Health Care Practice Guideline Study Chlamydia screening for women Osteoporosis screening for women Eligible Patients Women ages years old Women ages 65 years and older Criteria that meets Screening for Chlamydia recorded in previous year Screening for Bone Densitometry recorded since 65th birthday and/or Procedures, or Procedures, or Diagnoses Cancer Screening Practice Guideline Study Cervical cancer screening Eligible Patients Women ages years old without Hysterectomy recorded in DX, Procedures Criteria that meets Pap Smear recorded in previous 3 years or, for women ages 30 to 65 years, Pap smear and HPV test recorded in previous 5 years Breast cancer screening Women ages years old Mammogram recorded in previous 2 years Colorectal cancer screening Adults ages years old FOB test recorded in past year as a OR Sigmoidoscopy in previous 5 years, or Colonoscopy in previous 10 Pap Smear- or Procedures, or Diagnoses HPV Test-, or Procedures, or Diagnoses FOB- Laboratory Results Sigmoidoscopy & Colonoscopy- Procedures, Diagnoses

8 Infectious Disease Screening Practice Guideline Study Eligible Patients HIV screening Patients ages years old Hepatitis C Screening Patients born between 1945 and 1965 Criteria that meets HIV screening lab result ever recorded Hepatitis C screening lab result ever recorded Laboratory Result Laboratory Result Immunizations Practice Guideline Study Tetanus Influenza Pneumococcal Pneumococcal: high risk patients Eligible Patients Patients ages 12 years and older Patients ages 6 months old and older Patients ages 65 years and older Patients ages years old with active DX of Diabetes Mellitus, Criteria that meets Recorded in the previous 10 years Recorded in the past year Ever recorded Ever recorded, or Health Maintenance, or Diagnoses, or Procedures, or Medications, or Health Maintenance, or Diagnoses, or Procedures, or Medications, or Health Maintenance, or Diagnoses, or Procedures, or Medications, or Health Maintenance, or

9 Hepatitis A Heart Failure, COPD, Chronic Kidney Disease, Alcohol Abuse, or Alcohol Dependence Adults with active DX of Chronic Liver Disease Meningococcal Patients ages years old HPV Zoster (shingles) Patients ages 9-26 years old Patients ages 60 years old and older Two ever recorded Ever recorded Three ever recorded Ever recorded Diagnoses, or Procedures, or Medications, or Health Maintenance, or Diagnoses, or Procedures, or Medications, or Health Maintenance, or Diagnoses, or Procedures, or Medications, or Health Maintenance, or Diagnoses, or Procedures, or Medications, or Health Maintenance, or Diagnoses, or Procedures, or Medications Mental Health and Substance Abuse Practice Guideline Study Eligible Patients Criteria that meets

10 Depression screening (adults) All adult patients Active DX of Depression or Screening for Depression recorded in previous 2 years DX or Depression- Problem List and/or Diagnoses Anti-depressant medication management Adults with active DX of Depression A current prescription recorded for an antidepressant medication Alcohol misuse: screening All adult patients Active DX of Alcohol Abuse, Alcohol Dependence, or High- Risk Drinker -or- Screening for Alcohol use recorded in previous 2 years as a lab result or in DX, Procedures, or Risks Patients with alcohol diagnosis or at-risk drinking with alcohol counseling in past year Adults with active DX of Alcohol Abuse, Alcohol Dependence or "at risk" drinking Alcohol Counseling or Brief Intervention recorded in past year Depression Screening-Laboratory result or Problem List, or Diagnoses, or Procedures, or Risks Dx- Problem List and/or Diagnoses Screening for Alcohol use- Laboratory result or Problem List, or Diagnoses, or Procedures, or Risks Laboratory result or Diagnoses, or Procedures, or Risks Patients with alcohol diagnosis with current alcohol prescription Adults with active DX of Alcohol Abuse or Alcohol Dependence A current prescription recorded for an alcohol medication Tobacco Use: Screening and cessation intervention Patients ages 18 years old and older DX of Tobacco Abuse or Screening for Tobacco use recorded in previous 2 years AND- who received cessation counseling intervention if identified as a tobacco user DX of Tobacco Abuse or Screening for Tobacco use- Laboratory results, or Vital Signs, or Risks Tobacco cessation counseling/ intervention-

11 Diagnoses, or Procedures Respiratory Disease Practice Guideline Study Use of appropriate medications for asthma Appropriate treatment for children with upper respiratory infection (URI) Appropriate treatment for adults with upper respiratory infection (URI) Patients with sinusitis/strep pharyngitis/otitis media/copd exacerbation prescribed antibiotics with narrow spectrum antibiotic Rx Eligible Patients Patients 5 years old and older with active DX of asthma Patients 3months-17 years with DX in previous month of the common cold, pharyngitis, or acute bronchitis (excludes visits with concomitant diagnoses of otitis media, pneumonia, sinusitis, streptococcus or COPD) Adults with DX in previous month of the common cold, pharyngitis, or acute bronchitis (excludes visits with concomitant diagnoses of otitis media, pneumonia, sinusitis, streptococcus or COPD) exacerbation) Adults with DX in previous month of acute sinusitis, strep pharyngitis, otitis media, or COPD exacerbation with a prescription recorded for an antibiotic medication within 3 days of the DX Criteria that meets A current prescription recorded for an Anti-inflammatory (controller) medication No prescription recorded for an antibiotic medication within 3 days of the DX No prescription recorded for an antibiotic medication within 3 days of the DX The antibiotic prescription prescribed is a narrow spectrum antibiotic medication

12 Medication Safety Practice Guideline Study Use of high-risk medications in the elderly Eligible Patients Criteria that meets *Medication data does not include dosing frequency fields ( Rx measures relying on daily dose are not accurate) Patients ages 66 years old or older No current prescription recorded for Anticholinergics (benztropine) Antihistamines (diphenhydramine, doxylamine, hydroxyzine) Antithrombotics (dipyridamole, ticlopidine), Barbiturates (butalbital combinations), Centrally acting alpha agonists (guanfacine, methyldopa) Endocrine agents (thyroid USP, megestrol), GI antispasmodics and antiemetics (dicyclomine, scopolamine), Long-acting benzodiazepines (chlordiazepoxide, diazepam), Long-acting sulfonylureas (chlorpropamide, glyburide) Oral estrogens, Pain medications (indomethacin, ketorolac, meperidine) Phenothiazines (promethazine, prochlorperazine), Skeletal muscle relaxants (carisoprodol, cyclobenzaprine, metaxalone), Tricyclic antidepressants (amitriptyline, imipramine), Vasodilators (ergoloid)

13 Appropriate dosages of benzodiazepines in patients 65 years ^Appropriate dosages of H2 blockers in patients with decreased renal function Avoid Rx of anticholinergic in patients with Dx of dementia Avoid Rx for NSAID or Cox 2 Inhibitor in patients with Dx of heart failure, hypertension or chronic kidney disease Avoid Rx for thiazolidinedione in patients with Dx of heart failure Avoid metformin in patients with egfr < 30 ml/min per 1.73 m2 Serum creatinine measured in past year in patients with Rx for any ACE Inhibitor or A II inhibitor, digoxin, any diuretic, or metformin Patients ages 65 years old or older with current Benzodiazepine prescription Patients with GFR < 50 ml/min with current H-2 blocker prescription Patients with Dx of dementia Patients with Dx of Heart Failure Patients with Dx of Heart Failure Patients with most recent egfr < 30 ml/min per 1.73 m2 Patients with Rx for any ACE Inhibitor or A II Inhibitor, Digoxin, any diuretic, or Metformin Current Benzodiazepine prescription within daily dose limits: alprazolam 2mg, lorazepam 3mg, oxazepam 60mg, temazepam 15mg, and triazolam 0.25mg Current H-2 blocker prescription within daily dose limits: for cimetidine 1200mg, famotidine 20mg, nizatidine 150mg, ranitidine 150mg No current prescription recorded for an anticholinergic. Examples include: 1 st -generation antihistamines, anticholinergic rx for urinary incontinence, GI antispasmodics, skeletal muscle relaxants No current prescription recorded for NSAID or Cox 2 Inhibitor No current prescription recorded for thiazolidinedione No current prescription recorded for metformin A Serum creatinine lab result recorded in previous year

14 ^Serum creatinine measured in past six months in either (patients 65 years or with CrCl < 50 ml/min) and Rx for (ACE Inhibitor or A II Inhibitor) and K sparing diuretic Most recent Potassium measurement 3.5 meq/l in patients with Rx for any thiazide and potassium measure in past year Hemoglobin measured in past year in patients with Rx for any anti-platelet (excluding Aspirin) or oral anticoagulant Glucose measured in past year in patients with Rx for any antipsychotic Patients with active Rx for Warfarin with INR measured in past 45 days Patients with Dx of A-fib and Warfarin Rx with INR within the therapeutic range Either patients 65 years old OR with GFR < 50 ml/min) and Rx for (ACE Inhibitor or A II Inhibitor) and K Sparing diuretic Patients with Rx for any thiazide and Potassium measure in past year Patients with Rx for any Anti-Platelet (excluding Aspirin) or Oral Anticoagulant Patients with Rx for any Antipsychotic Patients with active Rx for Warfarin Patients with active Dx of Atrial fibrillation AND with an active Rx for Warfarin A Serum creatinine lab result recorded in previous 6 months Most recent Potassium in previous year that is 3.5 meq/l A Hemoglobin lab result recorded in previous year A Glucose lab result recorded in previous year A INR lab result recorded in previous 45 days A INR lab result recorded in the last 45 days with a value between Provider Report One row per usual provider assigned to active patients Percent Performance for each of 64 PPRNet measures PLR Registry Tab (one row per active patient) Demographics (11-12 columns) Patient ID/MRN (EPIC) Last Name First Name Provider Insurance 1 Insurance 2 (EPIC only)

15 Summary (3 columns) Vital Signs (6 columns) Problems/Diagnoses (14 columns) (23 columns) Procedures (13 columns) *date for most recent PPRNet ID Date of Birth Sex Age Race Number of variables eligible for SQUID SQUID Last BP Date Systolic Value Diastolic Value Alcohol Abuse Asthma Atrial Fibrillation COPD Dementia Depression Diabetes Mellitus Heart Failure Hyperlipidemia Cholesterol Date Cholesterol Value egfr Creatinine Date Creatinine Value Glucose Date Glucose Value HbA1c Date HbA1c Value HDL Date HDL Value Hemoglobin Date AAA Scrn Alcohol Scrn Alcohol Counsel Bone Density Scrn Last Encounter Date Number of CMS Chronic Conditions BMI Date Calculated BMI (calculates from height and weight Smoking Status Hypertension Ischemic Vascular Disease Liver Disease Chronic Kidney Disease Tobacco Abuse Hemoglobin Val Hepatitis C Scrn Date HIV Scrn Date INR Date INR Value LDL Date LDL Value Microalbumin Date Microalbumin Value Potassium Date Potassium Value FOBT Hysterectomy Mammogram Pap Smear

16 Immunizations (7 columns) *date for most recent Vaccine Medications 26 columns *date for most recent active Rx of Active Medication Chlamydia Scrn Colonoscopy Depression Scrn Flu Vaccine Hepatitis A Vacc HPV Vaccine Meningococcal Vaccine ACE I or ARB Alcohol Rx Broad Spectrum Antibiotic Narrow Spectrum Antibiotic Anticoagulant Anticholinergic Antidepressant Antiplatelet Antipsychotic Asthma Controller Beta Blocker Cox 2 Inhibitor Digoxin Sigmoidoscopy Tobacco Counsel Pneumococcal Vaccine Tetanus Vaccine Zoster Vaccine Elderly Inappropriate H2 Blocker K-Sparing Diuretic Loop Diuretic Metformin NSAID Oral anti-coagulant Short Acting BZD Statin Rx Thiazide Rx Thiazolidinedione Tobacco Rx Warfarin Other Patient Level Reports CMS PQRS- Diabetes Mellitus Group Criteria by PQRS ID #: Description #1: HgbA1c lab measured in previous 12 months AND most recent result is 9% #110: Influenza Vaccine recorded in previous year #3: Most recent systolic BP <140 and diastolic < 90 in previous 6 months #117: A dilated eye exam recorded in Procedures in previous year #226: Screening for Tobacco use recorded in previous 2 years AND who received cessation counseling intervention if identified as a tobacco user #163: A diabetic foot exam recorded in Procedures in previous year

17 CMS Chronic Care Management In Calendar Year (CY) 2015, CMS will begin making separate payment under the Medicare Physician Fee Schedule (PFS) for chronic care management (CCM) services under Current Procedure Terminology (CPT) code CCM services are non-face-to-face care management/coordination services for certain Medicare beneficiaries having multiple (two or more) chronic conditions. ^^^ACC/AHA Cholesterol Guidelines for ASCVD Risk Reduction in Adults The 2013 ACC/AHA Guideline for Management of Blood Cholesterol recommends moderate- or high-intensity statin therapy for these four groups: Patients who have cardiovascular disease; Patients with an LDL, or bad cholesterol level of 190 mg/dl or higher; Patients with Type 2 diabetes who are between 40 and 75 years of age; and Patients with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years of age PPRNet Groupings CMS MU Clinical Quality s CMS ACO Clinical Quality s U.S Preventive Services Task Force Recommendations CDC Advisory Committee on Immunization Practices Recommendations NIAAA Alcohol Screening and Intervention Recommendations CDC Get Smart Treatment Guidelines for URI s CMS PQRS Clinical Quality Groupings (DM, IVD, CVD Prevention)

18 *Allison J, Kiefe CI, Weissman NW: Can data-driven benchmarks be used to set the goals of Healthy People 2010? Am J Public Health 1999; 89(1):61-5. ^estimated CrCl Cockcroft = [((140-age)*wt in kg)/72*scr] (females *0.85). ^^GFR by MDRD = 175 x SerumCr * age * (if patient is black) * (if female) ^^^ Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol Jul 1;63(25 Pt B): [144 references] PubMed