Performance Measurement Accelerating Improvement (2006) / Chapter Skim
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Appendix G Starter Set of Measures
Appendix G Starter Set of Measures
Pages 204-221
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7. Pneumonia vaccination Percentage of patients who ever received a pneumo coccal vaccine Coronary Artery Disease (CAD)
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APPENDIX G 205 TABLE G-1 continued discharge) (Note: this measure was not reviewed by the NQF and therefore it is not approved)
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11. Coronary artery bypass graft (CABG)
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APPENDIX G 207 TABLE G-2 continued Hospital Quality Alliance Publicly Reported Measures on CMS' NQF Endorsed Measures (cont'd.) Hospital Compare 12.
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who had at least one mammo gram in the past 2 years Cervical cancer screeningH Percentage of women aged 2164 years (as of Dec 31 of the measurement year) who were enrolled in a health plan and who had one Pap test in the past 3 years Chlamydia screening in womenA Percentage of sexually active female plan members who had at least one test for chlamydia during the previous year.
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Both the systolic and diastolic pressure must have been at or under these thresholds for the person's blood pressure to be considered controlled Beta-blocker treatment after a Percentage of members 35 years and older who were heart attackH hospitalized and discharged alive during the measure ment year with a diagnosis of a heart attack and who received a prescription for a beta-blocker upon discharge Persistence of beta-blocker The percentage of members 35 years and older who treatment after a heart attackA were discharged alive from July 1 of the year prior to the measurement year to June 30 of the measurement year with a diagnosis of a heart attack and who received persistent beta-blocker treatment. Persistent treatment is defined as receiving treatment for 6 mos after the discharge Cholesterol management after Percentage of health plan members 1875 years of age acute cardiovascular eventH, C who had evidence of an acute cardiovascular event and whose LDL-C was screenedH; controlled to less than 130 mg/dLC in the year following the event; and controlled to less than 100 mg/dLC Comprehensive diabetes careH, C Percentage of members with type 1 and type 2 diabetes who were 1875 years old and, during the measure ment year, had a hemoglobin A1c (HbA1c)
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S The percentage of commercial members 5064 years of age as of September 1 of the measurement year who received an influenza vaccination between September 1 of the measurement year and the date on which the CAHPS 3.0H Adult Survey was completed Flu shots for older adultsS The percentage of Medicare members 65 years of age and older as of January 1 of the measurement year who received an influenza vaccination from Septem ber 1December 31 of the year prior to the measure ment year Pneumonia vaccination status The percentage of Medicare members 65 years of age for older adultsS and older as of January 1 of the measurement year who received a pneumococcal vaccine Medicare Health Outcomes This measure provides a general indication of how SurveyS well a Medicare MCO manages the physical and mental health of its members. The survey measures each member's physical and mental health status at the beginning and the end of a 2-year period
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APPENDIX G 211 TABLE G-3 continued A 2-year change score is calculated and each member's physical and mental health status is categorized as better, the same, or worse than expected, taking into account risk adjustment factors. MCO-specific results are assigned as percentages of members whose health status was better, the same, or worse than expected Management of urinary Discussing Urinary Incontinence.
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212 APPENDIX G TABLE G-3 continued · children 711 and adolescents 1219 years of age who had a visit with an MCO primary care practitioner during the measurement year or the year prior to the measurement year Prenatal and postpartum careH Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the MCO in the first trimester or within 42 days of enrollment in the MCO Postpartum Care.
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Results summarize member experiences through ratings, composites, and individual question summary rates Four global rating questions reflect overall satisfaction with the following: · Rating of All Health Care · Rating of Health Plan · Rating of Personal Doctor · Rating of Specialist Seen Most Often Six composite scores summarize responses in key areas: · Claims Processing · Courteous and Helpful Office Staff · Customer Service · Getting Care Quickly · Getting Needed Care · How Well Doctors Communicate Children with Chronic ConditionsS This measure assesses parents' satisfaction with their child's MCO for the population of children with chronic conditions. Six composites summarize satisfac tion with basic components of care essential for successful treatment, management, and support of children with chronic conditions: · Access to Prescription Medicines · Access to Specialized Services · Family Centered Care: Personal Doctor or Nurse Who Knows Child (continued on next page)
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· Getting Treatment Quickly · How Well Clinicians Communicate · Access to Treatment and Information from the MBHO · Informed About Treatment Options Question Summary Rates. · Office Wait Times · Informed About Medication Side Effects · Received Information About Managing Condition · Informed About Patient Rights · Ability to Refuse Medicine or Treatment Health Plan StabilityA Practitioner turnoverA From the MCO provider database: · the percentage of primary care physicians affili ated with the MCO as of December 31 of the year prior to the measurement year who were not affiliated with the MCO as of December 31 of the measurement year · the percentage of nonphysician primary care practitioners affiliated with the MCO as of December 31 of the year prior to the measure ment year who were not affiliated with the MCO as of December 31 of the measurement year For the Medicaid product line only, the MCO also reports the same percentages for the following practitioners: · OB/GYN and other prenatal care practitioners · chemical dependency practitioners · mental health practitioners · dentists Years in business/total The number of years since licensure (the number of membershipA years that each product line has existed)
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For these deliveries, the MCO: · identifies the actual number of prenatal care visits rendered while they were enrolled in the MCO · identifies the number of expected visits · calculates the ratio of received-to-expected visits · reports an unduplicated count of deliveries had <21 percent; 2140 percent, 4160 percent, 61 80 percent or 81 percent of the number of expected visits, adjusted for the month the member enrolled and the MCO and gestational age. The MCO reports five rates Well-child visits in the first 15 The percentage of enrolled members who turned 15 months of lifeH months old during the measurement year and who had the following number of well-child visits with a primary care practitioner during their first 15 months of life: zero; one; two; three; four; five; six or more Well-child visits in the third, The percentage of members who were three, four, five, fourth, fifth, and sixth years of or six years of age during the measurement year who lifeH received one or more well-child visits with a primary care practitioner during the measurement year Adolescent well-care visitsH The percentage of enrolled members who were 1221 years of age who had at least one comprehensive well care visit with a primary care practitioner or an OB/ GYN practitioner during the measurement year Frequency of selected proceduresA This measure provides a summary of the number and rate of several frequently performed procedures- myringotomy, tonsillectomy, nonobstetric dialation and curettage, hysterectomy, cholecystectomy, laminectomy/diskectomy, angioplasty, cardiac catheterization, coronary artery bypass graft, pros (continued on next page)
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Inpatient utilization -- nonacute This measure summarizes utilization of nonacute careA inpatient care in hospice, nursing home, rehabilitation, SNF, transitional care and respite. These data exclude services with a principal diagnosis of mental health and chemical dependency Discharge and average length of Utilization of maternity-related care for enrolled stay -- maternity care A females who had live births during the measurement year, reported for total deliveries, vaginal deliveries and Cesarean section (C-section)
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If a newborn is transferred from one hospital to another and has never gone home, the care is still newborn care. Newborn care that is rendered after the baby has been dis charged should be reported in Table IPU-A (Inpatient Utilization -- General Hospital/Acute Care)
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) during the measurement year, stratified by age Cost of Care Informed Health Care Choices Health Plan Descriptive InformationA Board certificationA The percentage of the following physicians who are board certified: · primary care physicians · OB/GYN physicians · pediatric physician specialists · geriatricians · all other physician specialists Board certification refers to the various specialty certifi cation programs of the American Board of Medical Specialties and the American Osteopathic Association.
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AAdministrative data. HHybrid (administrative specifications, optionally augmented by chart record abstraction)
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Acute care hospitalization Percentage of patients who had to be admitted to the hospital 10. Emergent care Percentage of patients who need urgent, unplanned medical care 11.
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APPENDIX G 221 TABLE G-6 NHQR's ESRD Measures (5 measures) Process Percentage of dialysis patients registered on a waiting list for transplantation Percentage of patients with treated chronic kidney failure who receive a transplant within 3 years of renal failure Outcome Percentage of hemodialysis patients with urea reduction ratio of 65 or greater Percentage of patients with hematocrit of 33 or greater Patient survival rate
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