Appropriateness Ratings of 24 Measures
| 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 visit | Not 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.