Adult Weight Screening and Follow-Up (NQF 0421)
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1 Adult Weight Screening and Fllw-Up (NQF 0421) EMeasure Name Adult Weight Screening and EMeasure Id Pending Fllw-Up Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December 31, 20xx Measure Steward Quality Insights f Pennsylvania Endrsed by Descriptin Measure scring Measure type Ratinale Natinal Quality Frum Percentage f patients aged 18 years and lder with a calculated BMI in the past six mnths r during the current visit dcumented in the medical recrd AND if the mst recent BMI is utside parameters, a fllw-up plan is dcumented. Prprtin Prcess Of the Medicare ppulatin, 37 percent are verweight, and 18 percent are bese. Between 1991 and 1998, the prevalence f besity amng persns age increased by 45 percent (American Obesity Assciatin). Accrding t a 1998 survey, nly 52 percent f adults age 50 r lder reprted being asked during rutine medical check-ups abut physical activity r exercise. The likelihd f being asked abut exercise during a rutine check-up declined with age (Center fr the Advancement f Health, 2004). Clinical Recmmendatin Statement Elderly patients with unintentinal weight lss are at higher risk fr infectin, depressin and death. In ne study it was fund that a BMI f less than 22 kg per m2 in wmen and less than 23.5 in men is assciated with increased mrtality. In anther study it was fund that the ptimal BMI in the elderly is 24 t 29 kg per m2. (Huffman, G. B., Evaluatin and Treatment f Unintentinal Weight Lss in the Elderly, American Family Physician, 2002 Feb, 4: ) The USPSTF (2009) recmmends that clinicians screen all adult patients fr besity and ffer intensive cunseling and behaviral interventins t prmte sustained weight lss fr bese adults. (Level f Evidence = B, USPSTF) The clinical guideline fr besity recmmends assessment f BMI at each encunter (Natinal Heart, Lung and Bld Institute). Management f Obesity indicates that the bdy mass index shuld be calculated at least annually fr screening and as needed fr management (The Institute fr Clinical Systems Imprvement s 2009 Guideline fr Preventin and Management f Obesity). Validated measure f nutritin status serves as an indicatr f ver-nurishment and under-nurishment. Nutritin Screening Initiative: Nutritin Interventins Manual fr Prfessinals Caring fr Older Americans, 2002 (C-spnsred by American Dietetic Assciatin (ADA), AAFP and Natinal Cuncil n Aging, Inc.). The NSI-suggested BMI range is (values utside this range indicate
2 Imprvement ntatin Measurement duratin References Definitins verweight r underweight fr elderly) Nutritin Screening Initiative: Nutritin Interventins Manual fr Prfessinals Caring fr Older Americans, 2002 (Cspnsred by American Dietetic Assciatin (ADA), AAFP and Natinal Cuncil n Aging, Inc.). Higher scre indicates better quality 12 mnths Table f Cntent Ppulatin criteria 1 Ppulatin criteria 2 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 1 Initial Patient Ppulatin = AND: Patient characteristic: birth date (age) >= 65 years; Denminatr = AND: All patients in the initial patient ppulatin; AND: >=1 cunt(s) f Encunter: encunter utpatient ; Numeratr 1 = OR: Physical exam finding: BMI >=22 kg/m² and <30 kg/m², ccurring <=6 mnths befre r simultaneusly t the Encunter: utpatient encunter ; OR: Physical Exam Finding: BMI >=30 kg/m², ccurring <=6 mnths befre r simultaneusly t the Encunter: utpatient encunter ; OR: Care gal: fllw-up plan BMI management ; OR: Cmmunicatin prvider t prvider: dietary cnsultatin rder ; OR: Physical Exam Finding: BMI <22 kg/m², ccurring <=6 mnths befre r simultaneusly t the Encunter: utpatient encunter ; OR: Care gal: fllw-up plan BMI management ; OR: Cmmunicatin prvider t prvider: dietary cnsultatin rder ;
3 Exclusins = OR: Patient characteristic: Terminal illness <=6 mnths befre r simultaneusly t Encunter: encunter utpatient ; OR: Diagnsis active: Pregnancy ; OR: Physical exam nt dne: patient reasn ; OR: Physical exam nt dne: medical reasn ; OR: Physical ratinale physical exam nt dne: system reasn ; Ppulatin criteria 2 Initial Patient Ppulatin = AND: Patient characteristic: birth date (age) >= 18 years AND <= 64 years; Denminatr = AND: All patients in the initial patient ppulatin ; AND: >=1 cunt(s) f Encunter: encunter utpatient ; Numeratr 2 = OR: Physical exam finding: BMI >=18.5 kg/m² and <25 kg/m², ccurring <=6 mnths befre r simultaneusly t the Encunter: utpatient encunter ; OR: Physical Exam Finding: BMI >=25 kg/m², ccurring <=6 mnths befre r simultaneusly t the Encunter: utpatient encunter ; OR: Care gal: fllw-up plan BMI management ; OR: Cmmunicatin prvider t prvider: dietary cnsultatin rder ; OR: Physical Exam Finding: BMI >=25 kg/m², ccurring <=6 mnths befre r simultaneusly t the Encunter: utpatient encunter ; OR: Care gal: fllw-up plan BMI management ; OR: Cmmunicatin prvider t prvider: dietary cnsultatin rder ; Exclusins = OR: Patient characteristic: Terminal illness <=6 mnths befre r simultaneusly t Encunter: encunter utpatient ; OR: Diagnsis active: Pregnancy ; OR: Physical exam nt dne: patient reasn ; OR: Physical exam nt dne: medical reasn ; OR: Physical ratinale physical exam nt dne: system reasn ; Data criteria (QDS Data Elements) Initial Patient Ppulatin =
4 "Patient characteristic: birth date using birth date cde list befre the beginning f the measurement perid ; Denminatr = All patients in the initial patient ppulatin ; Encunter: encunter utpatient during the measurement perid ; Numeratr = Care plan: fllw-up BMI management plan using fllw-up BMI management plan cde list during the Encunter: utpatient encunter ; Cmmunicatin prvider t prvider: dietary cnsultatin rder using dietary cnsultatin rder cde list during the Encunter: utpatient encunter ; Physical exam finding: BMI using BMI cde list befre r simultaneusly t the Encunter: utpatient encunter ; Exclusins = Physical exam nt dne: patient reasn using patient reasn cde list fr Physical Physical exam nt dne: medical reasn using medical reasn cde list fr Physical Physical exam nt dne: system reasn using system reasn cde list fr Physical Diagnsis active: pregnancy using pregnancy cde list during Encunter: encunter utpatient ; Patient characteristic: terminal Illness using terminal illness cde list befre r simultaneusly t Encunter: encunter utpatient ; 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.
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