Article Figures & Data
Tables
Does it matter to patients? 1. Patient-oriented outcome: For an outcome measure, the outcome is important to patients (improves quality or quantity of life). For a process measure, the action is likely to lead to an outcome that is important to patients. 2. Autonomy preserved (shared decision-making): Patient autonomy is preserved for decisions in which reasonable, informed patients may make different choices. Is it appropriately specified? 3. Denominator specification: The population is clearly and adequately specified with appropriate exclusion criteria and assessment method. 4. Numerator specification: The outcome being measured is clearly and adequately specified with appropriate timeframe and assessment method. Is there sufficient evidence that benefitsoutweigh harms and costs? 5. Certainty of net benefit: There is sufficient evidence that the action(s) proposed by the quality measure generate desirable consequences that outweigh undesirable consequences.
6. Measure implementation improves outcomes: There is sufficient evidence that actual implementation of the measure will lead to desirable consequences that outweigh undesirable consequences.
7. Resource use: Measure implementation is likely to produce net benefits that justify the resources (human, material, and financial) expended on its implementation (care provision, measurement, and reporting).Does the measure assess quality, independent of significant confounding factors? 8. Gaming resistance: Measure implementation is unlikely to motivate a significant number of healthcare providers to change their patient selection, clinical decision-making behavior, or reporting in ways that improve measure performance without improving health outcomes if the measure is implemented.
9. Locus of control: The entity for whom the quality of care is being measured can have sufficient authority, influence, or capacity to affect performance on the quality measure.
10. Social determinants of health: Social determinants of health of the population served do not unduly influence performance on the measure.Name Description Appropriateness Evaluation Criteria NotSatisfied ACP Review Controlling High Blood Pressure The percentage of members 18 to 85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg) during the measurement year Not Appropriate 2, 3, 5 Uncertain validity Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) Percentage of patients 18 to 75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period Appropriate Uncertain validity CG-CAHPS (MHQP Version) Composites: Getting Timely Appointments, Care, and Information; How Well Providers Communicate; Providers' Use of Information to Coordinate Patient Care, Helpful, Courteous, and Respectful Office Staff; Patient's Rating of Provider Appropriate Not rated Depression Screening and Follow-Up for Adolescents and Adults Percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care.
• Depression Screening. The percentage of members who were screened for clinical depression using a standardized tool.
• Follow-Up on Positive Screen. The percentage of members who screened positive for depression and received follow-up care within 30 days.Appropriate Uncertain validity Depression Remission at Six or Twelve Months Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at six or twelve months defined as a PHQ-9 score less than 5. This measure applies to patients with both newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment. Not Appropriate 4 Not rated Depression Remission and Response for Adolescents and Adults Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at six or twelve months defined as a PHQ-9 score less than 5. Not Appropriate 4 Not rated Depression Response at Six or Twelve Months - Progress Toward Remission Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate a response to treatment at six or twelve months defined as a PHQ-9 score that is reduced by 50% or greater from the initial PHQ-9 score. Appropriate Not rated Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment Percentage of adolescent and adult patients with a new episode of alcohol or other drug (AOD) dependence who received appropriate follow-up care:
• Initiation of AOD Treatment. The percentage of patients who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis.
• Engagement of AOD Treatment. The percentage of patients who initiated treatment and who had two or more additional services with a diagnosis of AOD within 30 days of the initiation visitNot appropriate 4,9 Not rated Childhood Immunization Status (Combo 10) Percentage of children that turned 2 years old during the measurement year and had specific vaccines by their second birthday Appropriate Not rated Immunizations for Adolescents (Combo 2) Percentage of adolescents that turned 13 years old during the measurement year and had specific vaccines by their 13th birthday Appropriate Not rated Influenza Immunization Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization Appropriate Valid Chlamydia Screening - Ages 16 to 24 Percentage of women ages 16 to 24 that were identified as sexually active and had at least one test for Chlamydia during the measurement year Appropriate Valid Colorectal Cancer Screening Percentage of adults 50 to 75 years of age who had appropriate screening for colorectal cancer Appropriate Valid Breast Cancer Screening Percentage of women 50 to 74 years of age who had a mammogram to screen for breast cancer Not Appropriate 2,5 Valid Cervical Cancer Screening Percentage of women 21 to 64 years of age, who received one or more Pap tests to screen for cervical cancer Appropriate Valid Asthma Medication Ratio Percentage of patients 5 to 64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year Appropriate Not rated* Comprehensive Diabetes Care: Eye Exam Percentage of patients 18 to 75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months before the measurement period Appropriate Not rated Comprehensive Diabetes Care: Blood Pressure Control (<140/90 mm Hg) Percentage of members 18 to 75 years of age with diabetes (type 1 and type 2) whose most recent blood pressure (BP) reading is < 140/90 mm Hg during the measurement year Not Appropriate 2,3,5 Uncertain validity Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk Appropriate Not rated Follow-Up After Hospitalization for Mental Illness (30-Day) Percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an OP visit, an intensive OP encounter, or partial hospitalization with a mental health practitioner. Two rates are reported (1) the percentage of members who received follow-up within 30 days of discharge, 2) the percent of members who received follow-up within 7 days of discharge Appropriate at system level of application but Not Appropriate at individual practitioner level Not rated Follow-Up After Hospitalization for Mental Illness (7-Day) Percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental health disorders and who had an OP visit, an intensive OP encounter, or partial hospitalization with a mental health practitioner. Two rates are reported: 1) the percentage of members who received follow-up within 30 days of discharge, 2) the percent of members who received follow-up within 7 days of discharge Appropriate at system level of application but Not Appropriate at individual practitioner level Not rated Follow-up After Emergency Department Visit for Mental Health (7-Day) The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness, who had a follow-up visit for mental illness. Two rates are reported:1. The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).2. The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days). Appropriate at system level of application but Not Appropriate at individual practitioner level Not rated Continuity of Pharmaco- therapy for Opioid Use Disorder Percentage of adults 18 to 64 years of age with pharmacotherapy for opioid use disorder (OUD) who have at least 180 days of continuous treatment Appropriate Not rated Use of Imaging Studies for Low Back Pain Percentage of patients 18 to 50 years of age with a diagnosis of low back pain who did not have an imaging study (plain Radiograph, MRI, CT scan) within 28 days of the diagnosis Appropriate Valid *Merit-based Incentive Payment System (MIPS) measure 444 is an alternative, and is rated Valid by the ACP Criteria not satisfied (from Table 1) 2. Autonomy not preserved 3. Denominator not appropriately specified 4. Numerator not appropriately specified 5. Benefits do not clearly outweigh harms 9. Confounders such as Locus of Control Abbreviations: PHQ, patient health questionnaire; OUD, opioid use disorder; AOD, alcohol or other drug dependence; ACP, american college of physicians.
