Diabetes: HbA1c Control (<8%) (NQF 0575)

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1 Diabetes: HbA1c Cntrl (<8%) (NQF 0575) EMeasure Name Diabetes: HbA1c Cntrl < 8% EMeasure Id Pending Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December 31, 20xx Measure Steward Natinal Cmmittee fr Quality Assurance Endrsed by Natinal Quality Frum Descriptin The percentage f patients years f age with diabetes (type 1 r type 2) wh had HbA1c <8.0%. Measure scring Prprtin Measure type Prcess Ratinale This measure evaluates the percentage f patients in a specific age demgraphic wh were diagnsed with type 1 r type 2 diabetes and wh demnstrate adequate bld sugar cntrl with an HbA1c level lwer than 8 percent. Diabetes mellitus (diabetes) is a grup f diseases characterized by high bld glucse levels caused by the bdy s inability t crrectly prduce r utilize the hrmne insulin. It is recgnized as a leading cause f death and disability in the U.S. and is highly underreprted as a cause f death. Diabetes f either type may cause lifethreatening, life ending r life altering cmplicatins, including pr bld sugar cntrl. Studies have shwn that imprved glycemic cntrl is crrelated with a 40% decline in the develpment f assciated micrvascular cmplicatins (i.e., eye, kidney and nerve diseases)( ADA 2009). Clinical guidelines recmmend regular HbA1c testing t facilitate patients ability t imprve and sustain acceptable levels (ADA 2009). This measure facilitates the maintenance and lngterm management f adequate bld sugar levels fr patients diagnsed with diabetes. Clinical American Geriatric Sciety: Recmmendatin Statement Fr frail lder adults, persns with life expectancy f less than 5 years, and thers in whm the risks f intensive glycemic cntrl appear t utweigh the benefits, a less stringent target such as 8% is apprpriate. (Level III, Grade B) Fr lder persns, target hemglbin A1C shuld be individualized. A reasnable gal fr A1C in relatively healthy adults with gd functinal status is 7% r lwer. (Level III, Grade B) American Diabetes Assciatin: Lwering A1C t belw r arund 7% has been shwn t reduce micrvascular and neurpathic cmplicatins f type 1 and type 2 diabetes. Therefre, fr micrvascular disease preventin, the A1C gal fr nnpregnant adults in general is <7%. (A) In type 1 and type 2 diabetes, randmized cntrlled trials f intensive versus standard glycemic cntrl have nt shwn a significant reductin

2 References Definitins in CVD utcmes during the randmized prtin f the trials. Lng term fllw up f the Diabetes Cntrl and Cmplicatins Trial (DCCT) and UK Prspective Diabetes Study (UKPDS) chrts suggests that treatment t A1C targets belw r arund 7% in the years sn after the diagnsis f diabetes is assciated with lng term reductin in risk f macrvascular disease. Until mre evidence becmes available, the general gal f <7% appears reasnable fr many adults fr macrvascular risk reductin. (B) Subgrup analyses f clinical trials such as the DCCT and UKPDS and the micrvascular evidence frm the ADVANCE (Actin in Diabetes and Vascular Disease: Preterax and Diamicrn MR Cntrlled Evaluatin) trial suggest a small but incremental benefit in micrvascular utcmes with A1C values clser t nrmal. Therefre, fr selected individual patients, prviders might reasnably suggest even lwer A1C gals than the general gal f <7%, if this can be achieved withut significant hypglycemia r ther adverse effects f treatment. Such patients might include thse with shrt duratin f diabetes, lng life expectancy, and n significant CVD. (B) Cnversely, less stringent A1C gals than the general gal f <7% may be apprpriate fr patients with a histry f severe hypglycemia, limited life expectancy, advanced micrvascular r macrvascular cmplicatins, and extensive cmrbid cnditins and thse with lngstanding diabetes in whm the general gal is difficult t attain despite diabetes selfmanagement educatin, apprpriate glucse mnitring, and effective dses f multiple glucse lwering agents including insulin. (C ) Guidelines fr Imprving the Care f the Older Persn with Diabetes Mellitus. Califrnia Healthcare Fundatin/American Geriatrics Sciety Panel n Imprving Care fr Elders with Diabetes. American Geriatrics Sciety. May 2003 Vl. 51, N. 5 Supplement, JAGS. Standards f Medical Care in Diabetes Diabetes Care January :S6 S12; di: /dc09 S006 Table f Cntents Ppulatin criteria Data criteria (QDS Data Elements) Summary calculatin Please refer t the spreadsheet fr this measure fr detail regarding data criteria and cde lists. Ppulatin criteria Initial Patient Ppulatin =

3 AND: Patient characteristic: birth date (age) >=17 years and <=74 years t capture all patients wh will reach the ages between 18 and 75 years during the measurement perid ; Denminatr = AND: All patients in the initial patient ppulatin; AND: Numeratr = OR: medicatin dispensed: medicatins indicative f diabetes <=2 years befre r simultaneusly t OR: medicatin rder: medicatins indicative f diabetes <=2 years befre r simultaneusly t OR: medicatin active: medicatins indicative f diabetes <=2 years befre r simultaneusly t OR: Diagnsis active: diabetes <=2 years befre r simultaneusly t OR: >=1 cunt(s) f Encunter: encunter acute inpatient r ED ; OR: >=2 cunt(s) f Encunter: encunter nn acute inpt, utpatient, r phthalmlgy ccurring n 2 AND: Labratry test result: HbA1c test, MOST RECENT value < 8.0%; Exclusins = OR: Diagnsis active: plycystic varies ; AND NOT: Diagnsis active: diabetes <= 2 years befre r simultaneusly t OR: Encunter: encunter acute inpatient r ED <=2 years befre r simultaneusly t OR: Encunter: encunter nn acute inpt, utpatient, r phthalmlgy <=2 years befre r simultaneusly t OR:

4 AND NOT: OR: Diagnsis active: gestatinal diabetes <=2 years befre r simultaneusly t OR: Diagnsis active: sterid induced diabetes <=2 years befre r simultaneusly t OR: Medicatin rder: medicatins indicative f diabetes <=2 years befre r simultaneusly t OR: Medicatin dispensed: medicatins indicative f diabetes <=2 years befre r simultaneusly t OR: Medicatin active: medicatins indicative f diabetes <=2 years befre r simultaneusly t Diagnsis active: diabetes <=2 years befre r simultaneusly t Data criteria (QDS Data Elements) Initial Patient Ppulatin = OR: Encunter: Encunter acute inpatient r ED <=2 years befre r simultaneusly t OR: Encunter: encunter nn acute inpt, utpatient, r phthalmlgy <=2 years befre r simultaneusly t Patient characteristic: birth date using birth date cde list befre the measurement perid Denminatr = Diagnsis active: diabetes using diabetes cde list gruping befre r simultaneusly t the Encunter: encunter acute inpatient r ED using encunter acute inpatient r ED cde list gruping during the measurement perid ; Encunter: encunter nn acute inpt, utpatient, r phthalmlgy using encunter nn acute inpt, utpatient, r phthalmlgy cde list gruping during the measurement perid ; Medicatin rder: medicatins indicative f diabetes using medicatins indicative f diabetes cde list gruping befre r simultaneusly t the

5 Medicatin dispensed: medicatins indicative f diabetes using medicatins indicative f diabetes cde list gruping befre r simultaneusly t the measurement end date ; Medicatin active: medicatins indicative f diabetes using medicatins indicative f diabetes cde list gruping befre r simultaneusly t the Numeratr = Labratry test result: HbA1c test using HbA1c test cde list gruping during the measurement perid ; Exclusins = Diagnsis active: plycystic varies using plycystic varies cde list gruping befre r simultaneusly t the Diagnsis active: gestatinal diabetes using gestatinal diabetes cde list gruping befre r simultaneusly t the Diagnsis active: sterid induced diabetes using sterid induced diabetes cde list gruping befre r simultaneusly t the Summary calculatin Calculatin is generic t all measures: Calculate the final denminatr by adding all that meet denminatr criteria. Subtract frm the final denminatr all that d nt meet numeratr criteria yet als meet exclusin criteria. Nte sme measures d nt have exclusin criteria. The perfrmance calculatin is the number meeting numeratr criteria divided by the final denminatr. Fr measures with multiple patient ppulatins, repeat this prcess fr each patient ppulatin and reprt each result separately. Fr measures with multiple numeratrs, calculate each numeratr separately within each ppulatin using the paired exclusin. Measure set CLINICAL QUALITY MEASURE SET

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