Diabetes: Bld Pressure Management (NQF 0061) EMeasure Name Diabetes: Bld Pressure Management 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 18 75 years f age with diabetes (type 1 r type 2) wh had BP <140/90 mmhg. 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 sustain adequate bld pressure cntrl. 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 life threatening, life ending r lifealtering cmplicatins, including pr bld pressure cntrl and subsequent cardivascular disease f varying severity. Maintaining a healthy bld pressure has been shwn t reduce cmplicatins due t diabetes, with a 10 mm Hg reductin in systlic bld pressure lwering the risk f cmplicatins by 12% It als reduces the chance f cardivascular disease amng patient with diabetes by up t 50% and reduces the chance f ther related cmplicatins (eye, kidney, nerve) by mre than 25% This measure facilitates lng term management f bld pressure levels fr patients diagnsed with diabetes. Clinical Recmmendatin Statement American Assciatin f Clinical Endcrinlgists and American Cllege f Endcrinlgy (AACE/ACE): Recmmends that a bld pressure determinatin during the initial evaluatin, including rthstatic evaluatin, be included in the initial and every interim physical examinatin. American Cllege f Physicians (ACP): Bld pressure cntrl must be a pririty in the management f persns with hypertensin and type 2 diabetes. American Diabetes Assciatin (ADA): Bld pressure shuld be measured at every rutine diabetes visit. Patients fund t have systlic bld pressure >130 mmhg r diastlic >80 mmhg shuld have bld pressure cnfirmed n a separate day. Orthstatic measurement f bld pressure shuld be perfrmed t assess fr the presence f autnmic neurpathy. (Level f Evidence: E) American Geriatrics Sciety (AGS): Older persns with diabetes are likely t benefit greatly frm cardivascular risk reductin, therefre mnitr and treat hypertensin and dyslipidemias. JNC VII: Recmmends that measurement f bld pressure in the standing
psitin is indicated peridically, especially in thse at risk fr pstural hyptensin. At least tw measurements shuld be made and the average recrded. After BP is at gal and stable, fllw up visits can usually be at 3 t 6 mnth intervals. C mrbidities such as heart failure, assciated diseases such as diabetes, and the need fr labratry tests influence the frequency f visits. Natinal Kidney Fundatin (NKF): Recmmends that all individuals shuld be evaluated during health encunters t determine whether they are at increased risk f having r f develping chrnic kidney disease. This evaluatin f risk factrs shuld include bld pressure measurement. References American Assciatin f Clinical Endcrinlgists and American Cllege f Endcrinlgy. The American Assciatin f Clinical Endcrinlgists Medical Guidelines fr the Management f Diabetes Mellitus: The AACE System f Intensive Diabetes Self Management 2002 Califrnia Healthcare Fundatin/American Geriatrics Sciety (AGS) Imprving Care f Elders with Diabetes. Guidelines fr Imprving the Care f the Older Persn with Diabetes Mellitus. J Am Geriatr Sc 2003;51:S265 S280. Available at http://ww.americangeriatrics.rg/educatin/diabetes_executive_summary.shtml Accessed September 2004. Definitins The Seventh Reprt f the Jint Natinal Cmmittee n Preventin, Detectin, Evaluatin, and Treatment f High Bld Pressure (JNC VII). NIH Publicatin N. 04 5230, August 2004. 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 = 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 = All patients in the initial patient ppulatin;
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 different dates; OR: Physical exam finding: diastlic bld pressure, MINIMUM value < 90 mmhg during MOST RECENT Encunter: encunter nn acute inpt, utpatient, r phthalmlgy ; OR: Physical exam finding: diastlic bld pressure, MINIMUM value < 90 mmhg during MOST RECENT Encunter: Encunter acute inpatient r ED ; Exclusins = OR: Physical exam finding: systlic bld pressure, MINIMUM value < 140 mmhg during MOST RECENT Encunter: encunter nn acute inpt, utpatient, r phthalmlgy ; OR: Physical exam finding: systlic bld pressure, MINIMUM value < 140 mmhg during MOST RECENT Encunter: Encunter acute inpatient r ED ; 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: 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 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 = Physical exam finding: diastlic bld pressure using diastlic bld pressure cde list during the measurement perid ; Physical exam finding: systlic bld pressure using systlic bld pressure cde list 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 2011 2012