RULES SPECIFICATIONS VERSION: 1.8 DATE: SEPTEMBER 9, 2010 CLASS.: PROPRIETARY, FOR CLIENT USE AUTHORS: Y. CHIANG

Transcription

1 RULES SPECIFICATIONS Massachusetts Group Insurance Commission (GIC) Posting Book of Physician Quality Profiler (PQP) Measures, Clinical Performance Improvement Initiative (CPII) Round 7 VERSION: 1.8 DATE: SEPTEMBER 9, 2010 CLASS.: PROPRIETARY, FOR CLIENT USE AUTHORS: Y. CHIANG Resolution Health, Inc. Proprietary Statement: This material constitutes proprietary and trade secret information of Resolution Health and shall not be disclosed to any third party, nor used by the recipient except under the terms and conditions prescribed by Resolution Health. This material is not to be copied or reproduced in any form, using any medium, without the prior written authorization of Resolution Health. Disclaimer of Currency: Resolution Health documentation reflects the state of products, software, reports, and procedures as of the publication date. All information is subject to change without notice. Additional changes to products and systems occur as needed, but may not be documented until a later date. Resolution Health, Inc Little Patuxent Parkway, Suite 610 Columbia, MD

2 PQP Measures CPII Round 7 for GIC i TABLE OF CONTENTS 1 Introduction Measures for CPII Cancer Surveillance... 2 Rule 11923: Breast cancer history annual surveillance (NQF)... 2 Rule 10220: Prostate cancer annual cancer surveillance (NQF) Cardiac Measures Atrial Fibrillation... 4 Rule 11941: Atrial fibrillation and stroke risk on warfarin (NQF)... 4 Rule 1972: Atrial fibrillation no TFT (NQF)... 5 Rule 211: Atrial fibrillation warfarin INR check... 6 Rule 412: Amiodarone baseline thyroid test (NQF)... 7 Rule 219: Warfarin 2 month prothrombin time test (NQF) Heart Failure... 9 Rule 11931: Heart failure ACE-I or ARB use (NQF)... 9 Rule 11933: Heart Failure on Beta Blocker (NQF) Rule 175: CHF avoid DHP calcium channel blocker Coronary Heart Disease Rule 398: CHD post-mi on ACE inhibitor (NQF) Rule 157: CHD post-mi on beta blocker Rule 3798: HEDIS CHD cholesterol management Rule 2682: Bare metal stent antiplatelet within 30 days Rule 4141: Drug-eluting stent antiplatelet 12 months (NQF) Rule 383: HEDIS MI hospitalization beta blocker 6 months Hypertension Rule 11398: HTN had creatinine test (NQF) Rule 152: New hypertension glucose test Rule 153: New hypertension potassium test Rule 154: New hypertension lipid test Rule 174: Hypertension avoid SA DHP calcium channel blocker Rule 388: HEDIS Antidepressant med at least 6 months Rule 2432: New bipolar disorder on antimanic agent (NQF)... 24

3 PQP Measures CPII Round 7 for GIC ii 2.3 Drug Safety Measures Rule 395: HEDIS ACEI or ARB annual potassium and creatinine Rule 377: HEDIS Digoxin annual potassium and creatinine Rule 394: HEDIS Diuretics annual potassium and creatinine Rule 390: HEDIS Anticonvulsants annual drug level Rule 401: Clozapine white blood cell count Rule 2427: Lithium annual creatinine test (NQF) Rule 2428: Lithium annual thyroid function test (NQF) Rule 2424: Lithium annual drug level test (NQF) Rule 423: Benign prostatic hypertrophy avoid anticholinergic Endocrine Measures Diabetes Rule 10228: DM and insulin use evidence of self monitoring (NQF) Rule 11399: DM on meds had creatinine test (NQF) Rule 381: HEDIS Diabetes annual hemoglobin A1c Rule 380: HEDIS Diabetes annual LDL Rule 172: Diabetes hypertension nephropathy on ACE or ARB Rule 382: HEDIS Diabetes annual nephropathy screening Rule 2431: New diabetes on metformin Dyslipidemia Rule 11373: Lipid Rx noncompliance (NQF) Rule 185: Dyslipidemia new med 3 month lipid panel (NQF) Gasteroenterology Rule 413: IBD and chronic steroid bone density test Rule 426: Hepatitis C viral load testing (NQF) Gynecology Rule 12079: Endometerial ablation appropriate prior workup (NQF) Hematology Measures Rule 424: Pulmonary embolism antithrombotic med (NQF) Rule 425: Deep vein thrombosis antithrombotic med (NQF) HIV Rule 11410: HIV high risk had screening (NQF) Mental Behavioral Health Depression Rule 222: Depression avoid anxiolytic without antidepressant Rule 397: HEDIS Antidepressant med at least 12 weeks... 50

4 PQP Measures CPII Round 7 for GIC iii ADHD Rule 3804: HEDIS ADHD med follow-up visit within 30 days Rule 3812: HEDIS ADHD med follow-up visits within 9 months Nephrology Rule 11382: Chronic kidney disease need annual lipid test (NQF) Rule 11378: Chronic kidney disease monitor calcium (NQF) Rule 11374: Chronic kidney disease monitor parathyroid hormone (NQF) Rule 11379: Chronic kidney disease monitor phosphorus (NQF) Neurology Rule 11401: Migraine had prophylactic medication (NQF) Rule 2686: New dementia thyroid and B12 tests Opthalmology Rule 4393: Cataract surgery and no post-op complication Otolaryngology Rule 4396: Otitis media effusion no systemic antimicrobials Rule 4397: Acute otitis externa avoid systemic antibiotics Rule 4399: Tympanostomy tube hearing test (NQF) Prenatal Care Measures Rule 11387: Pregnant woman needs Hepatitis B screening (NQF) Rule 11381: Pregnant woman needs HIV screening (NQF) Rule 11386: Pregnant woman needs syphilis screening (NQF) Rule 233: Prenatal diabetes avoid oral hypoglycemic meds (NQF) Preventive Health Measures Women s Health Rule 168: High risk cervical cancer screening (NQF) Rule 183: HEDIS Cervical cancer screening in past 3 years Rule 389: HEDIS Osteoporosis management post fracture Rule 384: HEDIS Chlamydia annual screening Rule 182: HEDIS Breast cancer screening in past 2 years Well Child Visits Rule 5607: Age 0-1 year old appropriate office visits Rule 5608: Age 1-3 years old appropriate office visits Rule 7842: Age 3-11 years old appropriate office visits Rule 7843: Age 12 to 18 years of age appropriate office visits... 75

5 PQP Measures CPII Round 7 for GIC iv 2.16 Pulmonary Measures Asthma Rule 228: Persistent asthma beta-2 agonist Rule 2376: HEDIS Persistent asthma appropriate med COPD Rule 11397: COPD on long acting bronchodilator (NQF) Rule 10216: COPD spirometry to confirm diagnosis (NQF) Rule 225: Asthma or COPD avoid beta-2 agonist overuse Rule 6747: HEDIS COPD corticosteroid post discharge Rule 7304: HEDIS COPD bronchodilator post discharge Other Respiratory Rule 385: HEDIS Pharyngitis appropriate testing Rule 386: HEDIS Upper respiratory infection appropriate med Rule 3817: HEDIS Acute bronchitis avoid antibiotics Rheumatology Osteoporosis Rule 11380: Osteoporosis on pharmacological therapy (NQF) Rule 10226: Osteopenia and chronic steroids on osteoporosis Rx (NQF) Rule 11390: Steroid use osteoporosis screening (NQF) Rheumatoid Arthritis Rule 4314: Rheumatoid arthritis annual ESR or CRP (NQF) Rule 3794: HEDIS Rheumatoid arthritis DMARD therapy Rule 4313: Rheumatoid arthritis 3 month ESR or CRP test (NQF) Rule 4311: Rheumatoid arthritis DMARD baseline CBC (NQF) Rule 4361: Rheumatoid arthritis DMARD baseline creatinine (NQF) Rule 4362: Rheumatoid arthritis DMARD baseline AST or ALT (NQF) Rule 2426: Rheumatoid arthritis hydroxychloroquine eye exam (NQF) Rule 2690: Methotrexate 3 month CBC test (NQF) Rule 2688: Methotrexate 3 month creatinine test (NQF) Rule 2687: Methotrexate 3 month liver function test (NQF)... 98

6 PQP Measures CPII Round 7 for GIC 1 1 Introduction The quality measurement of physicians is based on identifying evidence-based care, using computer algorithms to identify patients who meet the requirements of each measure. This document describes each of the measures that Resolution Health, Inc. currently uses for its physician quality profiling (PQP) activities. For each quality of care measure, the following information is provided: Measure Title This title is used when reporting measure results for providers and plans. Measure Description The measure description provides the overall purpose of the measure. and The numerator is the number of measure-eligible patients whose care appears to be consistent with evidence-based guidelines, according to the available claims data. The denominator is the number of patients eligible for the measure (i.e., the patients who have the relevant condition, or take the relevant drug, or have the relevant age/gender demographic, etc.). Applicable Specialties Resolution Health maps applicable (relevant) clinical specialties to each measure, and attributes each patient s care to the provider (1) who has a specialty mapped to the measure, and (2) who is considered a primary specialist for the patient. A patient s primary specialist is the physician within a given specialty who provides the most ambulatory care services to the patient (as identified using the member s prescription claims and medical claims for office visits during the most recent 18 months). Measure Citation The measure citation displays the organization (e.g., American Heart Association) that developed the clinical practice guideline upon which the quality measure is based, as well as citations to key publications related to the measure and a note as to whether the measure is programmed according to NCQA/HEDIS measure technical specifications. For more information about these measures, please contact the Resolution Health Client Manager for GIC PQP, Kate Burkitt: kburkitt@resolutionhealth.com.

7 PQP Measures CPII Round 7 for GIC 2 2 Measures for CPII Cancer Surveillance Rule 11923: Breast cancer history annual surveillance (NQF) NQF LINK This measure identifies female patients with history of breast cancer who had breast cancer surveillance in the past 12 months. Patients in the denominator who had breast cancer surveillance during the measurement year. Female patients 18 years or older with a history of breast cancer, excluding patients with a history of mastectomies and bilateral breast implants. nting/measure_submission_forms/cancer.aspx Family Practice, General Practice, Internal Medicine, Obstetrics & Gynecology, General Surgery National Comprehensive Cancer Network Practice Guidelines in Oncology- Breast Cancer V CA Cancer J Clin - Ongoing Care of Patients After Primary Treatment for Their Cancer 2003;53: Trends in Breast Cancer by Race and Ethnicity: Update 2006 CA Cancer J Clin 2006; 56: American Cancer Society.

8 PQP Measures CPII Round 7 for GIC 3 Rule 10220: Prostate cancer annual cancer surveillance (NQF) NQF LINK This measure identifies male patients with history of prostate cancer who have had their PSA monitored during the measurement year. Patients in the denominator who have had a PSA test or evidence of PSA monitoring during the measurement year Male patients diagnosed with prostate cancer anytime in the past prior to the measurement year, excluding patients actively being treated for prostate cancer during the measurement year. nting/measure_submission_forms/cancer.aspx Family Practice, General Practice, Internal Medicine, Urology National Comprehensive Cancer Network Practice Guidelines in Oncology - Prostate Cancer v American Cancer Society Guidelines for the Early Detection of Cancer: Update of Early Detection Guidelines for Prostate, Colorectal, and Endometrial Cancers; Author(s): Robert A. Smith, PhD, Andrew C. von Eschenbach, MD, Richard Wender, MD (for The Acs Prostate Cancer Advisory Committee), Bernard Levin, MD, Tim Byers, MD, David Rothenberger, MD, Durado Brooks, MD (for The Acs Colorectal Cancer Advisory Committee), William Creasman, MD, Carmel Cohen, MD, Carolyn Runowicz, MD, Debbie Saslow, MD, PhD (for the ACS Endometrial Cancer Advisory Committee), Vilma Cokkinides, PhD, Harmon Eyre, MD; RECENT DATA ON PROSTATE CANCER TESTING FOR EARLY DETECTION ;CA Cancer J Clin 2001; 51:38

9 PQP Measures CPII Round 7 for GIC Cardiac Measures Atrial Fibrillation Rule 11941: Atrial fibrillation and stroke risk on warfarin (NQF) NQF LINK This measure identifies patients with atrial fibrillation and other stroke risk who are taking warfarin therapy. Patients in the denominator who have evidence of warfarin use with days supply extending within 30 days of the analysis date or evidence of long-term anticoagulation in the past. Adult patients at least 25 years old with atrial fibrillation and major stroke risk factors including prior stroke, mitral stenosis, or mitral valve replacement, or 2 of the following: age>75, diabetes, hypertension, or CHF. ting/measure_submission_forms/cardiovascular_disease.aspx Family Practice, General Practice, Internal Medicine, Cardiology ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation Circulation. 2006;114:e257-e354. Racial Disparities in Receipt of Secondary Stroke Prevention Agents Among US Nursing Home Residents Stroke. 2003;34: Warfarin Use among Ambulatory Patients with Nonvalvular Atrial Fibrillation: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study Ann Intern Med Dec.

10 PQP Measures CPII Round 7 for GIC 5 Rule 1972: Atrial fibrillation no TFT (NQF) This measure identifies patients with new-onset atrial fibrillation during the measurement year who have had a thyroid function test 6 weeks before or after the diagnosis of atrial fibrillation. Patients in the denominator who had a thyroid function test 6 weeks before or after the diagnosis of atrial fibrillation. Adult patients with a new diagnosis of atrial fibrillation during the first 10.5 months of the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology Fuster V, Rydén LE, Zamorano JL. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Circulation. 2006;114:e257 e354.

11 PQP Measures CPII Round 7 for GIC 6 Rule 211: Atrial fibrillation warfarin INR check This measure identifies patients with atrial fibrillation diagnosed during the measurement year who started warfarin and who had an INR test within 2 weeks after the warfarin start date. Patients in the denominator who had an INR test within 2 weeks after the warfarin start date. Patients diagnosed with atrial fibrillation newly started on warfarin, excluding those with any ER visit or hospitalization 14 days after the warfarin start date. Family Practice, General Practice, Internal Medicine, Cardiology Hirsh J, Guyatt G, et al. American College of Chest Physicians Executive Summary. Antithrombotic and Thrombolytic Therapy 8th Ed: ACCP Guidelines. Chest 2008;133:71S 105S).

12 PQP Measures CPII Round 7 for GIC 7 Rule 412: Amiodarone baseline thyroid test (NQF) This measure identifies patients who had a TSH baseline measurement at the start of amiodarone therapy. Patients in the denominator who had TSH baseline measurement within 60 days prior to or 30 days after the start of amiodarone. Adult patients who started amiodarone during the first 11 months of the measurement year, without evidence of total thyroidectomy in the past. Family Practice, General Practice, Internal Medicine, Cardiology Batcher EL, Tang C. Thyroid Function Abnormalities during Amiodarone Therapy for Persistent Atrial Fibrillation. AJM , Siddoway LA. Amiodarone: guidelines for use and monitoring. Am Fam Physician. 2003;68(11): Baskin, HJ, Cobin RH, et al; AACE Thyroid Task Force. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism. Endocrine Practice. 2002;8(6):

13 PQP Measures CPII Round 7 for GIC 8 Rule 219: Warfarin 2 month prothrombin time test (NQF) This measure identifies patients taking warfarin during the measurement year who had at least 1 PT/INR test within 60 days after the earliest detected warfarin prescription. Patients in the denominator who had a PT/INR test within 60 days after the earliest observed warfarin prescription during the measurement year. Patients who are taking warfarin during the measurement year, excluding those with any ER visit or hospitalization during the 60 days after the earliest observed warfarin prescription during the measurement year. Family Practice, General Practice, Internal Medicine Hirsh J, Guyatt G, et al. American College of Chest Physicians Executive Summary. Antithrombotic and Thrombolytic Therapy 8th Ed: ACCP Guidelines. Chest 2008;133:71S 105S).

14 PQP Measures CPII Round 7 for GIC Heart Failure Rule 11931: Heart failure ACE-I or ARB use (NQF) NQF LINK This measure identifies patients with heart failure who are on an ACE-I or ARB medication. Patients in the denominator who are on an ACE-I or ARB medication in the last month of the measurement year. Patients 18 years or older who have a history of heart failure. nting/measure_submission_forms/cardiovascular_disease.aspx Family Practice, General Practice, Internal Medicine, Cardiology ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult Circulation. 2005;112:e154-e2355.

15 PQP Measures CPII Round 7 for GIC 10 Rule 11933: Heart Failure on Beta Blocker (NQF) NQF LINK This measure identifies patients with heart failure who are on a beta blocker. Patients in the denominator who are on a beta blocker in the last month of the measurement year. Patients 18 years or older who have been diagnosed with heart failure anytime in the past. nting/measure_submission_forms/cardiovascular_disease.aspx Family Practice, General Practice, Internal Medicine, Cardiology ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult Circulation. 2005;112:e154-e2355 Improved compliance with quality measures at hospital discharge with a computerized physician order entry system. Am Heart J Mar;151(3):643-53

16 PQP Measures CPII Round 7 for GIC 11 Rule 175: CHF avoid DHP calcium channel blocker This measure identifies patients with HF who are not taking a non-dihydropyridine calcium channel blocker (non-dhp CCB). Patients in the denominator who are not taking a non-dihydropyridine calcium channel blocker (non-dhp CCB) during the last 6 months of the measurement year. Patients with HF diagnosed prior to the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology Hunt SA, Abraham WT, et al Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation. 2009;119:e391 e479.

17 PQP Measures CPII Round 7 for GIC Coronary Heart Disease Rule 398: CHD post-mi on ACE inhibitor (NQF) This measure identifies patients with ST elevation MI (STEMI), or non-st elevation MI (NSTEMI) plus a history of hypertension, HF, and/or diabetes prior to the measurement year who are taking an ACEI or an ARB during the measurement year. Patients in the denominator with at least 1 prescription claim for an ACEI or an ARB during the measurement year. Patients with STEMI, or NSTEMI with hypertension, HF, and/or diabetes, prior to the measurement year who do not have a contraindication to ACEI/ARB therapy (contraindications include hyperkalemia, active pregnancy, and renal artery stenosis). Family Practice, General Practice, Internal Medicine, Cardiology Anderson JL, Adams CD, Antman EM. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction). Circulation. 2007;116: Antman EM, Anbe DT, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol. 2004;44:

18 PQP Measures CPII Round 7 for GIC 13 Rule 157: CHD post-mi on beta blocker This measure identifies patients diagnosed with acute myocardial infarction (AMI) prior to the measurement year who are taking a beta blocker during the measurement year. Patients in the denominator who have 1 Rx claim for a beta blocker during the measurement year. Patients with a diagnosis of AMI prior to the measurement year who do not have a contraindication to beta blockers (contraindications include: history of asthma, presence of inhaled corticosteroids, hypotension, 2 nd - or 3 rd -degree heart block or sinus bradycardia with no history of pacemaker, or COPD). Family Practice, General Practice, Internal Medicine, Cardiology Anderson JL, Adams CD, Antman EM. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction). Circulation. 2007;116: Antman EM, Anbe DT, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol. 2004;44:

19 PQP Measures CPII Round 7 for GIC 14 Rule 3798: HEDIS CHD cholesterol management This measure identifies patients from 18 through 75 years of age discharged alive for acute myocardial infarction (AMI), coronary bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) from January 1 through November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during or in the year prior to the measurement year, who had a LDL-C check during the measurement year. Patients in the denominator who had a lipid test within the measurement year. Patients with CHD diagnosed prior to the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology National Committee for Quality Assurance. HEDIS Vol 2. Washington, DC: National Committee for Quality Assurance; National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute; Antman EM, Anbe DT, et al. ACC-AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol. 2004;44:

20 PQP Measures CPII Round 7 for GIC 15 Rule 2682: Bare metal stent antiplatelet within 30 days This measure identifies patients undergoing percutaneous coronary intervention (PCI) with placement of a bare metal intracoronary stent during the first 11 months of the measurement year, who had a prescription for an antiplatelet Rx within 30 days after stent placement. Patients in the denominator with a prescription for an antiplatelet Rx within 30 days following stent placement. Patients who underwent PCI with placement of a bare metal intracoronary stent, during the first 11 months of the measurement year, excluding those with contraindications to antiplatelets. Family Practice, General Practice, Internal Medicine, Cardiology King SB III, Smith SC Jr, Hirshfeld JW Jr, Jacobs AK, Morrison DA, Williams DO focused update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: (2007 Writing Group to Review New Evidence and Update the 2005 ACC/AHA/SCAI Guideline Update for Percutaneous Coronary Intervention). Circulation. 2008;117: Grines CL, Bonow RO, Casey DE Jr, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation. 2007;115(6):813 8.

21 PQP Measures CPII Round 7 for GIC 16 Rule 4141: Drug-eluting stent antiplatelet 12 months (NQF) This measure identifies patients undergoing percutaneous coronary intervention (PCI) with placement of a drug-eluting intracoronary stent during the 3 months prior to the measurement year, who had consistent use of an antiplatelet Rx for 12 months following stent placement. Patients in the denominator who are taking an antiplatelet Rx consistently in the 12 months following placement of the drug-eluting intracoronary stent. Patients who underwent PCI with placement of a drug-eluting intracoronary stent, during the 3 months prior to the measurement year, excluding those with contraindications to antiplatelets. Family Practice, General Practice, Internal Medicine, Cardiology King SB III, Smith SC Jr, Hirshfeld JW Jr focused update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: (2007 Writing Group to Review New Evidence and Update the 2005 ACC/AHA/SCAI Guideline Update for Percutaneous Coronary Intervention). Circulation. 2008;117: Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA. 2007;297: Grines CL, Bonow RO, Casey DE Jr, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation. 2007;115(6):813 8.

22 PQP Measures CPII Round 7 for GIC 17 Rule 383: HEDIS MI hospitalization beta blocker 6 months This measure identifies patients ages 18 or older who were hospitalized for AMI and discharged from the hospital from July 1 of the year prior to the measurement year through June 30 of the measurement year who have been taking a beta blocker consistently for at least 6 months post discharge. Patients in the denominator who have 135 days supply of a beta blocker medication in the 6 months post AMI discharge Patients hospitalized and discharged with an AMI from July 1 of the year prior to the measurement year through June 30 of the measurement year, who do not have a contraindication to beta blockers (contraindications include: history of asthma or use of asthma medications, hypotension, 2 nd - or 3 rd -degree heart block or sinus bradycardia with no history of pacemaker, or COPD). Family Practice, General Practice, Internal Medicine, Cardiology National Committee for Quality Assurance. HEDIS 2010 Measures. Vol 2. Washington, DC: National Committee for Quality Assurance; 2009.

23 PQP Measures CPII Round 7 for GIC Hypertension Rule 11398: HTN had creatinine test (NQF) NQF LINK This measure identifies patients with hypertension who had a serum creatinine test during the measurement year. Patients in the denominator who had a serum creatinine test during the measurement year (and 90 days after). Patients 18 years or older who have been diagnosed with hypertension during the measurement year or the prior year who do not have a diagnosis of end stage renal disease during the measurement year (this exclusion is only applied if the numerator is not met). ting/measure_submission_forms/cardiovascular_disease.aspx Family Practice, General Practice, Internal Medicine Institute for Clinical Systems Improvement (ICSI). Health Care Guideline: Hypertension Diagnosis and Treatment (Released October 2006). Accessed July 14, URL: National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention and Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003;289:

24 PQP Measures CPII Round 7 for GIC 19 Rule 152: New hypertension glucose test This measure identifies patients with newly diagnosed hypertension during the measurement year with a lab claim for a serum glucose test at the time of diagnosis, if not done in the 6 months prior to diagnosis. Patients in the denominator who had a serum or plasma glucose test within 30 days after initial diagnosis of hypertension. Patients who meet criteria for newly diagnosed hypertension during the measurement year and who did not have a serum or plasma glucose test in the 6 months prior to diagnosis. Family Practice, General Practice, Internal Medicine, Cardiology Chobanian AV, et al. The Seventh Report of the Joint National Committee on prevention, detection, and evaluation and treatment of high blood pressure. NHLBI writing team NIH Publication No

25 PQP Measures CPII Round 7 for GIC 20 Rule 153: New hypertension potassium test This measure identifies patients with newly diagnosed hypertension during the measurement year with a lab claim for a serum potassium test at the time of diagnosis, if not done in the 6 months prior to diagnosis. Patients in the denominator who had a serum potassium test within 30 days after initial diagnosis. Patients who meet criteria for newly diagnosed hypertension during the measurement year and who did not have a serum potassium test in the 6 months prior to diagnosis. Family Practice, General Practice, Internal Medicine, Cardiology Chobanian AV, et al. The Seventh Report of the Joint National Committee on prevention, detection, and evaluation and treatment of high blood pressure. NHLBI writing team NIH Publication No

26 PQP Measures CPII Round 7 for GIC 21 Rule 154: New hypertension lipid test This measure identifies patients with newly diagnosed hypertension during the measurement year with a lab claim for a serum lipid panel test at the time of diagnosis, if not done in the year prior to diagnosis. Patients in the denominator who had a lipid panel test within 30 days after initial diagnosis of hypertension. Patients who meet criteria for newly diagnosed hypertension during the measurement year and who did not have a serum lipid panel test in the year prior to diagnosis. Family Practice, General Practice, Internal Medicine, Cardiology Chobanian AV, et al. The Seventh Report of the Joint National Committee on prevention, detection, and evaluation and treatment of high blood pressure. NHLBI writing team NIH Publication No

27 PQP Measures CPII Round 7 for GIC 22 Rule 174: Hypertension avoid SA DHP calcium channel blocker This measure identifies the percentage of patients with hypertension diagnosed before the measurement year who had fewer than 2 prescription claims for short-acting dihydropyridine calcium channel blockers (SA DHP CCB) within the past 6 months. Patients in the denominator who appropriately avoided SA-DHP-CCBs during the past 6 months. Patients with hypertension diagnosed before the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology Chobanian AV, et al. The Seventh Report of the Joint National Committee on prevention, detection, and evaluation and treatment of high blood pressure. NHLBI writing team NIH Publication No Furberg CD, Psaty BM, Meyer JV. Nifedipine. Dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995;92:

28 PQP Measures CPII Round 7 for GIC 23 Rule 388: HEDIS Antidepressant med at least 6 months This measure identifies patients with newly diagnosed depression who were started on an antidepressant, and who remained on medication for at least 180 days of a 231-day period following the start of an antidepressant. Patients in the denominator who remained on medication for at least 180 days of a 231-day period following the start of an antidepressant. Patients with depression, diagnosed from May 1 st of the preceding year through April 30 th of the measurement year, who started medication for depression at least 180 days prior to the end of the measurement year. Family Practice, General Practice, Internal Medicine, Psychiatry. National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, Practice guideline for the treatment of patients with major depressive disorder, Second Ed. American Psychiatric Association. April (rev Feb 2005)

29 PQP Measures CPII Round 7 for GIC 24 Rule 2432: New bipolar disorder on antimanic agent (NQF) This measure identifies the percentage of patients with newly diagnosed bipolar disorder who have received at least 1 prescription for a mood-stabilizing agent during the measurement year. Patients in the denominator who have received at least 1 prescription for a mood-stabilizing agent during the measurement year. Patients newly diagnosed as having bipolar disorder earlier than 30 days before the end of the measurement year. Family Practice, General Practice, Internal Medicine, Psychiatry Chou JC, Fazzio L. Maintenance treatment of bipolar disorder: Applying research to clinical practice. J Psychiatr Pract Sep;12(5): American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry Apr;159(4 Suppl):1 50.

30 PQP Measures CPII Round 7 for GIC Drug Safety Measures Rule 395: HEDIS ACEI or ARB annual potassium and creatinine This measure identifies patients age 18 or older who received at least a 50% MPR for ACE inhibitors or ARBs during the measurement year who had at least 1 serum potassium and either a serum creatinine or a blood urea nitrogen (BUN) test during the measurement year. Patients in the denominator who had at least 1 serum potassium and either a serum creatinine or a BUN test during the measurement year. Patients who had at least a 50% MPR for ACE inhibitors or ARBs during the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, 2009.

31 PQP Measures CPII Round 7 for GIC 26 Rule 377: HEDIS Digoxin annual potassium and creatinine This measure identifies patients age 18 or older who had at least a 50% MPR for digoxin during the measurement year who had at least 1 serum potassium and either a serum creatinine or a blood urea nitrogen (BUN) therapeutic monitoring test during the measurement year. Patients in the denominator who had at least 1 serum potassium and either a serum creatinine or a BUN test during the measurement year. Patients who had at least a 50% MPR for digoxin during the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, 2009.

32 PQP Measures CPII Round 7 for GIC 27 Rule 394: HEDIS Diuretics annual potassium and creatinine This measure identifies patients age 18 or older who had at least a 50% MPR for diuretics during the measurement year who had at least 1 serum potassium and either a serum creatinine or a blood urea nitrogen (BUN) therapeutic monitoring test during the measurement year. Patients in the denominator who had at least 1 serum potassium and either a serum creatinine or a BUN therapeutic monitoring test during the measurement year. Patients who had at least a 50% MPR for diuretics during the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, 2009.

33 PQP Measures CPII Round 7 for GIC 28 Rule 390: HEDIS Anticonvulsants annual drug level This measure identifies patients age 18 or older who had at least a 50% MPR for anticonvulsants during the measurement year who had at least 1 serum drug measurement (for the prescribed drug) during the measurement year. Patients in the denominator who had at least 1 serum drug measurement (for the prescribed drug) during the measurement year. Patients who had at least a 50% MPR for anticonvulsants during the measurement year. Family Practice, General Practice, Internal Medicine, Neurology National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, 2009.

34 PQP Measures CPII Round 7 for GIC 29 Rule 401: Clozapine white blood cell count This measure identifies the percentage of patients taking clozapine during the measurement year who have had a WBC test Patients in the denominator who have had a WBC test within 30 days of earliest observed clozapine prescription. Patients with 1 Rx claim for clozapine during the first 11 months of the measurement year. Family Practice, General Practice, Internal Medicine, Psychiatry Clozaril (clozapine) prescribing information. Novartis, Revised May Gerson, SL, Meltzer, H. Mechanisms of Clozapine-Induced Agranulocytosis. Drug Saf 1992; 7(Suppl 1):17.

35 PQP Measures CPII Round 7 for GIC 30 Rule 2427: Lithium annual creatinine test (NQF) This measure identifies the percentage of patients taking lithium who have had at least one creatinine test after the earliest observed lithium prescription during the measurement year. Patients in the denominator who received a serum creatinine test after the earliest observed lithium prescription during the measurement year. Patients who received at least a 292-day supply of lithium during the measurement year. Family Practice, General Practice, Internal Medicine, Psychiatry American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry Apr;159(4 Suppl):1 50. Freeman MP, Freeman SA. Lithium: clinical considerations in internal medicine. Am J Med Jun;119(6):

36 PQP Measures CPII Round 7 for GIC 31 Rule 2428: Lithium annual thyroid function test (NQF) This measure identifies the percentage of patients taking lithium who have had at least one thyroid function test after the earliest observed lithium prescription during the measurement year. Patients in the denominator who received a thyroid function test after the earliest observed lithium prescription during the measurement year. Patients who received at least a 292-day supply of lithium during the measurement year. Family Practice, General Practice, Internal Medicine, Psychiatry American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry Apr;159(4 Suppl):1 50. Freeman MP, Freeman SA. Lithium: clinical considerations in internal medicine. Am J Med Jun;119(6):

37 PQP Measures CPII Round 7 for GIC 32 Rule 2424: Lithium annual drug level test (NQF) This measure identifies the percentage of patients taking lithium who have had at least one lithium level test after the earliest observed lithium prescription during the measurement year. Patients in the denominator who received a lithium level test after the earliest observed lithium prescription during the measurement year. Patients who received at least a 292-day supply of lithium during the measurement year. Family Practice, General Practice, Internal Medicine, Psychiatry American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry Apr;159(4 Suppl):1 50.

38 PQP Measures CPII Round 7 for GIC 33 Rule 423: Benign prostatic hypertrophy avoid anticholinergic This measure identifies the percentage of male patients with benign prostatic hyperplasia (BPH) without claims for anticholinergic medication in the last 6 months of the measurement year. Patients in the denominator without prescriptions for anticholinergic medications in the last 6 months of the measurement year. Men with history of BPH, but without history of TURP procedure or radical prostatectomy. Family Practice, General Practice, Internal Medicine, Urology Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Arch Intern Med Dec 8 22;163(22):

39 PQP Measures CPII Round 7 for GIC Endocrine Measures Diabetes Rule 10228: DM and insulin use evidence of self monitoring (NQF) NQF LINK This measure identifies patients with diabetes taking insulin who have evidence of proper self-monitoring blood glucose testing during the measurement year. Patients in the denominator who filled a prescription for a glucometer or blood glucose test strips during the measurement year and the 3 months prior to the start of the measurement year. Patients from 18 through 75 years of age with a diagnosis of diabetes or who took an oral hypoglycemic prescription during the measurement year or the year prior to the measurement year, who have also filled a prescription for insulin in the last 7 months of the measurement year. nting/measure_submission_forms/diabetes.aspx Family Practice, General Practice, Internal Medicine, Endocrinology American Diabetes Association. Standards of Medical Care in Diabetes Diabetes Care 2008;31 (suppl 1):S12-54.

40 PQP Measures CPII Round 7 for GIC 35 Rule 11399: DM on meds had creatinine test (NQF) NQF LINK This measure identifies adults with diabetes who have had a serum creatinine test during the measurement year. Patients in the denominator who have had a serum creatinine test or an ACE-I/ARB therapeutic monitoring test during the measurement year (and 90 days after). Patients from 18 through 75 years of age with a diagnosis of diabetes or patients who have an oral hypoglycemic or insulin prescription during the measurement year or the year prior. Exclude members with 1 encounters during the measurement year for polycystic ovaries, gestational diabetes, or steroid-induced diabetes. ting/measure_submission_forms/diabetes.aspx Family Practice, General Practice, Internal Medicine, Endocrinology American Diabetes Association. Standards of Medical Care in Diabetes Diabetes Care 2008;31 (suppl 1):S12-54.

41 PQP Measures CPII Round 7 for GIC 36 Rule 381: HEDIS Diabetes annual hemoglobin A1c This measure identifies patients from 18 through 75 years of age who have diabetes and who had at least 1 HbA1c test during the measurement year. Patients in the denominator who had at least 1 serum HbA1c test during the measurement year. Patients with diabetes diagnosed during the measurement year or the year prior to the measurement year. Family Practice, General Practice, Internal Medicine, Endocrinology National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, 2009.

42 PQP Measures CPII Round 7 for GIC 37 Rule 380: HEDIS Diabetes annual LDL This measure identifies patients from 18 through 75 years of age who have diabetes and who had an LDL-C level checked during the measurement year. Patients in the denominator who had an LDL-C level checked during the measurement year. Patients with diabetes diagnosed during the measurement year or the year prior to the measurement year. Family Practice, General Practice, Internal Medicine, Endocrinology, Cardiology National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, 2009.

43 PQP Measures CPII Round 7 for GIC 38 Rule 172: Diabetes hypertension nephropathy on ACE or ARB This measure identifies patients with diabetes plus hypertension or nephropathy who are taking an ACE inhibitor or ARB during the measurement year. Patients in the denominator who have 1 Rx claim for an ACE inhibitor or an ARB during the measurement year. Patients with past medical history of diabetes plus hypertension or nephropathy diagnosed prior to the measurement year. Family Practice, General Practice, Internal Medicine, Cardiology, Endocrinology American Diabetes Association. Standards of Medical Care in Diabetes Diabetes Care, Vol 32, Supp 1, Jan 2009:S Chobanian AV, et al. The Seventh Report of the Joint National Committee on prevention, detection, and evaluation and treatment of high blood pressure. NHLBI writing team NIH Publication No

44 PQP Measures CPII Round 7 for GIC 39 Rule 382: HEDIS Diabetes annual nephropathy screening This measure identifies patients from 18 through 75 years of age who have diabetes and at least one nephropathy screening; or who had evidence of medical attention for existing nephropathy (diagnosis or treatment of nephropathy), who are taking ACE-I/ARBs, or who have had at least one visit with a nephrologist. The number of patients from the denominator who during the measurement year had at least one test for nephropathy screening; or who had evidence of medical attention for existing nephropathy (diagnosis or treatment of nephropathy), who are taking ACE- I/ARBs, or who have had at least one visit with a nephrologist. Patients with diabetes diagnosed during the measurement year or the year prior to the measurement year. Family Practice, General Practice, Internal Medicine, Endocrinology National Committee for Quality Assurance. HEDIS Washington, DC: National Committee for Quality Assurance. Technical Specifications Vol 2, 2009.

45 PQP Measures CPII Round 7 for GIC 40 Rule 2431: New diabetes on metformin This measure identifies the percentage of patients newly diagnosed with diabetes type 2 who were treated with Metformin within 3 months following diagnosis, excluding patients who were immediately started on insulin therapy. Patients in the denominator who have received at least 1 prescription claim for Metformin from diabetes diagnosis to 90 days after diagnosis. Patients newly diagnosed with diabetes type 2 during the first 9 months of the measurement year, excluding those with insulin prescription claims. Family Practice, General Practice, Internal Medicine, Endocrinology Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care Jan;32(1):

46 PQP Measures CPII Round 7 for GIC Dyslipidemia Rule 11373: Lipid Rx noncompliance (NQF) NQF LINK This measure identifies patients on a lipid medication who have remained adherent to taking the medication regularly. Patients in the denominator who have taken their lipid-lowering medication at least 80% of the time during the 6-month period after the initial prescription fill date. Patients 19 years old or older with a diagnosis of hyperlipidemia who filled a prescription for a lipid-lowering medication sometime from 6 through 18 months before the end of the measurement year, and who had at least 60 days of medication supply in the 6 months following the earliest prescription fill in this time period. ting/measure_submission_forms/hyperlipidemia_and_atherosclerosis.aspx Family Practice, General Practice, Internal Medicine, Cardiology, Endocrinology Miller, N.H., et al., The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals. Circulation, (4): p Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation, (25): p ICSI. Health Care Guideline: Lipid Management in Adults [cited January 9, 2008]; 10 th edition:[available from: