New Clinical Quality Measures for 2011

Core Clinical Quality Measures for Eligible Physicians (EPs)

To demonstrate meaningful use of electronic health records (EHRs) under the Final Rule, EPs must report six clinical quality measures. Of these, three are “core” quality measures, which include:

  • Hypertension: Blood Pressure Measurement
  • Preventive Care and Screening Measure Pair:
    • a. Tobacco Use Assessment
    • b. Tobacco Cessation Intervention
  • Adult Weight Screening and Follow-up

If the provider is unable to report on one of these clinical measures because the provider sees no patients addressed by the measures, three “alternate core requirements” are available for reporting:

  • Weight Assessment and Counseling for Children and Adolescents
  • Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old
  • Childhood Immunization Status

Menu Clinical Quality Measures for EPs

In addition to three core quality measures, to demonstrate meaningful use an EP must report on any three additional quality measures, as selected from a list of 38 possible measures.

Breast Cancer Screening Description: Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer

Smoking and Tobacco Use Cessation, Medical Assistance:

  • Advising smokers and tobacco users to quit
  • Discussing smoking and tobacco use cessation medications
  • Discussing smoking and tobacco use cessation strategies description

Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies

Adult Weight Screening and Follow-Up Description: Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:

  • Initiation
  • Engagement Description

The percentage of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit

Controlling High Blood Pressure: The percentage of patients 18 – 85 years of age who had a diagnosis of hypertension and whose BP was adequately controlled during the measurement year

Ischemic Vascular Disease (IVD) – Complete Lipid Panel and LDL Control: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal angioplasty (PTCA) from Jan. 1 – Nov. 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had a complete lipid profile performed during the measurement year and whose LDL-C<100 mg/dL

Anti-depressant Medication Management:

  • Effective Acute Phase Treatment
  • Effective Continuation Phase Treatment

The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment

Use of Appropriate Medications for Asthma: Percentage of patients 5 – 50 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement year. Report three age stratifications (5 – 11 years, 12 – 50 years, and total)

Hypertension: Blood Pressure Measurement: Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least two office visits, with blood pressure (BP) recorded

Weight Assessment and Counseling for Children and Adolescents: Percentage of patients 2 – 17 years of age who had an outpatient visit with a primary care physician (PCP) or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year

Preventive Care and Screening Measure Pair:

  • Tobacco Use Assessment – Percentage of patients aged 18 years and older who have been seen for at least 2 office visits who were queried about tobacco use one or more times within 24 months
  • Tobacco Cessation Intervention – Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits, who received cessation intervention

Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old Description: Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February)

Childhood Immunization Status Description: Percentage of children who, by their second birthday, have had the following vaccines:

  • four diphtheria, tetanus, and acellular pertussis (DTaP)
  • three polio (IPV)
  • one measles, mumps, and rubella (MMR)
  • two H influenza type B (HiB)
  • three hepatitis B (Hep B)
  • one chicken pox (VZV)
  • four pneumococcal conjugate (PCV)
  • two hepatitis A (Hep A)
  • two or three rotavirus (RV)
  • two influenza (flu)

The measure calculates a rate for each vaccine and nine separate combination rates.

Appropriate Testing for Children With Pharyngitis Description: Percentage of children 2 – 18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode

Pneumonia Vaccination Status for Older Adults Description: Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine

Asthma Pharmacologic Therapy Description: Percentage of patients aged 5 – 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment

Asthma Assessment Description: Percentage of patients aged 5 – 40 years with a diagnosis of asthma and who have been seen for at least two office visits, who were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms

Colorectal Cancer Screening Description: Percentage of adults 50 – 75 years of age who had appropriate screening for colorectal cancer

Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) Description: Percentage of patients, regardless of age, who gave birth during a 12-month period who were screened for HIV infection during the first or second prenatal care visit

Anti-D Immune Globulin Description: Percentage of D (Rh) negative, unsensitized patients, regardless of age, who gave birth during a 12-month period who received anti-D immune globulin at 26 – 30 weeks gestation

Cervical Cancer Screening Description: Percentage of women 21 – 64 years of age, who received one or more Pap tests to screen for cervical cancer

Chlamydia Screening for Women Description: Percentage of women 15 – 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Description: Percentage of patients aged 18 years and older with a diagnosis of heart failure and LVSD (LVEF < 40 percent) who were prescribed ACE inhibitor or ARB therapy

Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI) Description: Percentage of patients aged 18 years and older with a diagnosis of CAD and prior MI who were prescribed beta-blocker therapy

Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD Description: Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Description: Percentage of patients aged 18 years and older with a diagnosis of heart failure who also have LVSD (LVEF < 40 percent) and who were prescribed beta-blocker therapy

Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol Description: Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines)

Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation Description: Percentage of all patients aged 18 years and older with a diagnosis of heart failure and paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Description: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from Jan. 1 – Nov. 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of use of aspirin or another antithrombotic during the measurement year

Diabetes: Hemoglobin A1c Poor Control Description: Percentage of patients 18 – 75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c > 9.0 percent

Diabetes: Low Density Lipoprotein (LDL) Management and Control Description: Percentage of patients 18 – 75 years of age with diabetes (type 1 or type 2) who had LDL-C < 100 mg/dL

Diabetes: Blood Pressure Management Description: Percentage of patients 18 – 75 years of age with diabetes (type 1 or type 2) who had blood pressure < 140/90 mm Hg

Diabetes: Eye Exam Description: Percentage of patients 18 – 75 years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional

Diabetes: Foot Exam Description: The percentage of patients aged 18 – 75 years with diabetes (type 1 or type 2) who had a foot exam (visual inspection, sensory exam with monofilament, or pulse exam)

Ischemic Vascular Disease (IVD): Blood Pressure Management Description: Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from Jan. 1 –  Nov. 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and whose recent blood pressure is in control (< 140/90 mm Hg)

Hemoglobin A1c Control (< 8.0 percent) Description: The percentage of patients 18 – 75 years of age with diabetes (type 1 or type 2) who had hemoglobin A1c < 8.0 percent

Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Description: Percentage of patients aged 18 years and older with a diagnosis of POAG who have been seen for at least two office visits who have an optic nerve head evaluation during one or more office visits within 12 months

Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Description: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months

Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care Description: Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months

Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer Description: Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period

Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients Description: Percentage of patients aged 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients Description: Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer

Low Back Pain: Use of Imaging Studies Description: Percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis

Clinical Quality Measures for Hospitals

Emergency Department Throughput – Admitted Patient’s Median Time From ED Arrival to ED Departure for Admitted Patients: Median time from emergency department arrival to time of departure from the ER for patients admitted to the facility from the ED

Emergency Department Throughput – Admitted Patients/Admission Decision Time to ED Departure Time for Admitted Patients: Median time from admit decision time to time of departure from the ED of ED patients admitted to inpatient status

Ischemic Stroke – Discharge on Anti-thrombotics: Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge

Ischemic Stroke – Anticoagulation for A-fib/Flutter: Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge

Ischemic Stroke – Thrombolytic Therapy for Patients Arriving Within Two Hours of Symptom Onset: Acute ischemic stroke patients who arrive at this hospital within two hours of time last known well and for whom IV t-PA was initiated at this hospital within three hours of time last known well

Ischemic or Hemorrhagic Stroke – Antithrombotic Therapy by Day Two: Ischemic stroke patients administered antithrombotic therapy by the end of hospital day two

Ischemic Stroke – Discharge on Statins: Ischemic stroke patients with LDL ≥ 100 mg/dL, or LDL not measured, or, who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge

Ischemic or Hemorrhagic Stroke – Stroke Education: Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke

Ischemic or Hemorrhagic Stroke – Rehabilitation Assessment: Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services

VTE Prophylaxis Within 24 Hours of Arrival: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission

Intensive Care Unit VTE Prophylaxis Description: This measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer)

Anticoagulation Overlap Therapy: This measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they must be discharged on both medications. Overlap therapy must be administered for at least five days with an international normalized ratio (INR) ≥ 2 prior to discontinuation of the parenteral anticoagulation therapy or the patient must be discharged on both medications

Platelet Monitoring on Unfractionated Heparin: This measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using defined parameters such as a nomogram or protocol

VTE Discharge Instructions: This measure assesses the number of patients diagnosed with confirmed VTE that are discharged to home, to home with home health, home hospice or discharged/transferred to court/law enforcement on warfarin with written discharge instructions that address all four criteria: compliance issues, dietary advice, follow-up monitoring, and information about the potential for adverse drug reactions/interactions

Incidence of Potentially Preventable VTE: This measure assesses the number of patients diagnosed with confirmed VTE during hospitalization (not present on arrival) who did not receive VTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date

Source: Federal Register, Table 6, pages 44398-44408 and Table 10, pages 44418-44420

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