Prepared by the Primary Care Coalition Approved January 29, Fiscal Year. Montgomery Cares Clinical Performance Measures

Transcription

1 Prepared by the Primary Care Coalition Approved January 29, 2015 Fiscal Year 2014 Montgomery Cares Clinical Performance Measures

2 Prepared by Approved by Quality Health Improvement Committee January 29, 2015

3 Table of Contents Executive Summary... 1 Background... 2 Results Reporting and Benchmarking... 3 Results... 3 Condition Specific Results... 5 Diabetes... 5 Hypertension (High Blood Pressure)... 6 Cancer Screening... 6 Breast Cancer Screening... 7 Cervical Cancer Screening... 7 Colorectal Cancer Screening... 8 Appendix I: Measure Definitions... 9 References...11 Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page

4 Executive Summary Fiscal year 2014 (July 1, 2013 to June 30, 2014) marks the seventh year that the Primary Care Coalition has published selected annual measures of clinical performance among clinics participating in Montgomery Cares. FY 2014 is the first reporting period in which all clinics are utilizing electronic medical records (EMRs); eight clinics transitioned to a shared EMR in the past fiscal year. The PCC anticipated drops in reported performance as clinics changed workflows and learned entirely new systems. Additionally, there were initial delays in establishing the interfaces between reference laboratories and the electronic medical record. Some clinics still do not have fully operational interfaces, and require manual data entry. Despite these challenges: Clinics have maintained many of the improvements from previous years in diabetes and hypertension management The Montgomery Cares program meets or exceeds HEDIS benchmarks in four of the seven reported chronic care measures, and has slipped to just below benchmarks in the other three measures Hypertension control approaches 90 th percentile performance Clinics have consistently and significantly improved screening rates for breast, cervical and colorectal cancers, though results remain below targeted performance Medical Directors from Montgomery Cares participating clinics recommended a revised set of measures to be tracked beginning January 1, Additionally, some changes to measure definitions and technical specifications were made for the FY 2014 annual reporting period to be more consistent with revised HEDIS metrics and evidence based guidelines. We gratefully acknowledge the physicians and staff of the twelve clinic organizations that participate in Montgomery Cares to serve Montgomery County s low income, uninsured populations. These clinical measures are only one reflection of their work and commitment to provide high quality health care to vulnerable county residents. The PCC appreciates the oversight and support provided by the Montgomery County Council and Montgomery County Department of Health and Human Services. The Montgomery Cares quality program has benefitted from the expertise of many partners. Much of the work that has driven these improvements over time has been supported by generous grant funding. The Primary Care Coalition thanks the following funders, who have made this measurement and process improvement work possible through the program s evolution. Adventist HealthCare Agency for Healthcare Research and Quality American Breast Cancer Foundation Bank of America CareFirst BlueCross BlueShield Consumer Health Foundation Communities IMPACT Diabetes Center/Centers for Disease Control and Prevention Maryland Department of Health and Mental Hygiene Meyer Foundation Susan G. Komen for the Cure Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 1

5 Background Since 1993, the Primary Care Coalition of Montgomery County, Maryland (PCC) has administered a variety of programs designed to increase access to health care and improve the quality of care in the Montgomery County health safety net. Montgomery Cares is a public-private partnership designed to provide health care to low income uninsured adults in Montgomery County. Montgomery Cares is composed of 12 independent safety-net primary care clinics, six hospitals, the Montgomery County Department of Health and Human Services, and the PCC, as well as volunteer health practitioners and other community-based organizations. Participating health care providers share a common mission and work collectively to provide highquality, efficient, accessible, equitable, and outcome-focused health services to low-income, uninsured adults in Montgomery County. In FY 2014, Montgomery Cares served more than 28,000 individuals. Two thirds of these patients are female and nearly two thirds (62%) self-identified as Hispanic. The patient population is racially diverse, including 18% Black, 16% White, 10% Asian, and 7% Native American, Alaskan, Hawaiian or Pacific Islander. Quality The Primary Care Coalition (PCC) and clinics participating in Montgomery Cares (MC) remain committed to improving the quality of health care provided though the program. Montgomery Cares Medical Directors meet quarterly to discuss quality-related issues including clinical process and outcome measures, best practices, and common challenges. Invited guests share expertise and resources. These meetings help to maintain and support clinic focus on quality improvement and guideline-concordant care, and identify opportunities for collaboration and technical assistance. In addition to quality improvement activities, Montgomery Cares performs on-site Quality Assurance (QA) reviews, and produces clinic-specific and aggregate reports. Clinics use this information to improve their care and services. Measurement has become an increasingly integral part of health care in the United States and is essential to improving quality. Between 2007 and 2009, PCC and Medical Directors from clinics participating in Montgomery Cares approved measure definitions and technical specifications in order to report and benchmark nationally endorsed measures of care. Community Clinic, Inc. (CCI), Mary s Center for Maternal and Child Health, and Spanish Catholic Center have had commercial electronic medical records (EMRs) for several years. Holy Cross Health Centers transitioned to a commercial EMR in the spring of The PCC led the roll-out of eclinical Works (ecw) in the remaining eight Montgomery Cares participating clinics in July through November of Quarterly and annual measures are produced using data from the PCC shared instance of ecw and from data provided by Mary s Center and Spanish Catholic Center. These annual measures reflect the work of nine clinics, serving 18,134 Montgomery Cares patients (65% of the Montgomery Cares patient population). CCI, Holy Cross Health Centers and Mercy Health Clinic are not represented in this report: CCI does not report clinical data to Montgomery Cares; Holy Cross Health Centers have not reported clinical data since their conversion to a commercial EMR in 2013; and, Mercy Health Clinic is not included in this year s report due to challenges in data entry and laboratory interfaces that may have resulted in under-reporting of clinical care. The table below shows reporting clinics for each of the past seven fiscal years. Clinics Reporting FY 2008 Clinics Reporting FY 2009 Clinics Reporting FY 2010 Clinics Reporting FY 2011 Clinics Reporting FY 2012 and FY 2013 Clinics Reporting FY 2014 Holy Cross Clinic Holy Cross Clinic Holy Cross Clinic Holy Cross Clinic Holy Cross Clinic (DM only) (DM only) (DM only) (DM only) (DM only) Mercy Clinic Mercy Clinic Mercy Clinic Mercy Clinic Mercy Clinic Mobile Med Mobile Med Mobile Med Mobile Med Mobile Med Mobile Med Muslim Community Center Medical Clinic (MCCMC) MCCMC MCCMC MCCMC MCCMC MCCMC Proyecto Salud Proyecto Salud Proyecto Salud Proyecto Salud Proyecto Salud Proyecto Salud Spanish Catholic Center (SCC) SCC SCC SCC SCC SCC The People s Community Wellness Clinic (TPCWC) TPCWC (mammo only) TPCWC TPCWC TPCWC TPCWC Chinese Culture Pan Asian Pan Asian Pan Asian and Community Services Center (Pan Asian) Mary s Center Mary s Center Mary s Center Mary s Center Mansfield MKC Kaseman Clinic (MKC) Under One Roof Under One Roof Care for Your Health (C4YH) MKC C4YH Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 2

6 Current Measures The PCC and clinic Medical Directors have selected measures for reporting based on several criteria, including: Existence of nationally endorsed measure specifications Evidence that improvement in the measures correlates with improved patient outcomes Sufficient prevalence of condition in the Montgomery Cares population HEDIS Medicaid results available to serve as meaningful benchmarks and performance targets where possible Montgomery Cares tracks 16 measures of chronic, preventive and wellness care on a quarterly basis. Ten clinical measures are presented in this annual report. Eight of these measures have been tracked over each of the seven fiscal years since Results Reporting and Benchmarking Where relevant public information is available, Montgomery Cares performance is benchmarked against HEDIS Medicaid HMO performance. HEDIS measure definitions are typically similar, but not identical to Montgomery Cares measure definitions (Appendix I). In calendar year 2013, more than 1,000 health plans voluntarily reported data to the National Committee for Quality Assurance (NCQA) for HEDIS reporting. These health plans represent more than half (54%) of lives covered through public and private insurance in the US. Participating plans have historically demonstrated higher quality than non-participating plans. The Medicaid plans against which Montgomery Cares benchmarks performance typically have more sophisticated infrastructure, more financial resources, and more specialty care access than Montgomery Cares participating clinics. HEDIS measures define eligible populations to include patients who have had consistent coverage throughout the reporting period, regardless of whether or not they were seen by a provider. Because Montgomery Cares is not yet an enrollment model, we define eligible populations to include patients who have been seen in a particular clinic at least once during the reporting period, and a second time during the reporting period or in the year previous. While recognizing that we do not share identical technical specifications, and the definition of eligible patients is a very significant difference, HEDIS Medicaid has been selected by PCC and participating Medical Directors as the most relevant public benchmarks for Montgomery Cares comparisons. In addition to absolute performance, PCC also reviews variation between clinics. Variation does not evaluate the clinical expertise of the providers, but rather the reliability of processes between clinics. Reduced variation signals improved reliability in planned care and/or data entry processes. In the following graphs, changes in the lowest and highest clinic results do not necessarily reflect performance in a single clinic; the highest and lowest performing clinics are not necessarily the same clinics year to year. The following pages highlight performance in fiscal years for each relevant measure. In early FY 2014, Montgomery Cares led the adoption of e-clinical Works, a certified commercial electronic medical record (EMR) to replace CHLCare in clinics that did not already have a commercial EMR. The availability of a commercial EMR was expected to better support recommended care and facilitate the efficient collection of clinical measure data. At the same time, the PCC anticipated that there could be a drop in FY 2014 reported indicators as Montgomery Cares participating clinics refined their use of the EMR, and established consistent processes for utilization of clinical data support systems, data entry and data collection. During the conversion to a PCC shared instance of the commercial electronic medical record there were initial delays in establishing the interfaces between reference laboratories and the electronic medical record. Some clinics still do not have fully operational interfaces, and require manual data entry. For most measures of chronic condition management, we have seen the anticipated drops, though generally smaller than we had expected. Results Despite the challenges inherent in a large EMR conversion, Montgomery Cares FY 2014 results demonstrate that: Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 3 Clinics have maintained many of the improvements from previous years in diabetes and hypertension management. The Montgomery Cares program meets or exceeds HEDIS benchmarks in four of the seven chronic care measures reported in this report, and has slipped to just below benchmarks in the other three measures Blood pressure control in diabetes and hypertension exceeds or approaches 90th percentile performance respectively Clinics have consistently and significantly improved screening rates for breast, cervical and colorectal cancers, though results remain below targeted performance The Montgomery County Council awarded additional FY 2014 funding to support breast and colorectal cancer screening among the eligible population. The PCC has worked with providers, vendors and participating clinics to provide sufficient supplies of mammograms, fecal immunoassay testing (FIT) and colonoscopies to meet projected demand

7 The table below summarizes Montgomery Cares performance in fiscal years , comparing Montgomery Cares results against the most recent HEDIS Medicaid benchmarks as published in NCQA State of Healthcare Quality 2014 (health plan performance in calendar year 2013). The following pages describe the importance of improving quality of care in the areas of diabetes, hypertension and cancer screening. For each measure, the graphs indicate overall Montgomery Cares performance, HEDIS Medicaid benchmarks, and the degree of variation between the highest and lowest performing Montgomery Cares clinic in each of the reported years. Measure FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 Target Range HEDIS 2013 Medicaid (Reported in 2014) (mean-90 th percentile) Diabetes: Annual A1c Testing 54% 74% 77% 83% 84% 84% 80% 84-92% Diabetes: Annual LDL Testing 47% 65% 70% 77% 75% 78% 75% 76-84% Diabetes: A1c Control (< 8) 53% 39% 45-59% *Diabetes: Poor A1c Control (> 9%) 57% 44% 37% 36% 42% 37% 38% 46-30% (lower is better for this measure only) *Diabetes: LDL Control (< 100 mg/dl) 22% 32% 35% 38% 38% 39% 36% 34-46% *Diabetes: BP Control (< 140/80) *** 60% 39-53% *Hypertension: BP Control ( 140/90) 52% 60% 65% 64% 62% 65% 69% 56-70% Breast Cancer Screening (>50 years old) 29% 32% 33% 40% 42% 58-71% Cervical Cancer Screening 7% 15% 29% 39% 50% 53% 55% 64-77% (last reported HEDIS 2013) Colorectal Cancer Screening 1% 2% 2% 3% 4% 8% 12% N/A These results reflect the aggregate performance of nine of the 12 Montgomery Cares participating clinics, representing thousands of patients. For each measure, the eligible population consists of patients who were seen at least once during FY 2014, and had a second visit during FY 2014 or FY The number of unduplicated patients seen in Montgomery Cares clinics in FY 2014 eligible for consideration in each measure is listed below. These numbers exclude CCI; Holy Cross Health Centers and Mercy Health Clinic. For Diabetes measures = 3,327 diabetic patients For Hypertension measure = 6,120 hypertensive patients For Breast Cancer Screening measure = 4,628 female patients years of age For Cervical Cancer Screening measure = 10,684 female patients years of age For Colorectal Cancer Screening measure = 7,399 male and female patients years of age Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 4

8 Condition Specific Results Diabetes Diabetes is a group of diseases characterized by high blood sugar levels. Diabetes is associated with serious, sometimes life threatening complications, and is the seventh leading cause of death in the U.S. The number of Americans with diabetes is increasing rapidly. In 2012, 29.1 million Americans (9.3% of the population) had diabetes. In 2010, 25.8 million (8.3% of the population) had diabetes 1. Diabetes is more prevalent in minority populations, affecting 7.6% of non-hispanic whites, 9.0% of Asian Americans, 12.8% of Hispanics, 13.2% of non- Hispanic blacks, and 15.9% of American Indians/Alaskan Natives 1. Diabetes, especially when unmanaged, can cause serious health complications, including heart disease and stroke, hypertension, kidney failure, lower-extremity amputation, blindness, and premature death. After adjusting for population, age, and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than expenditures in the absence of diabetes 1. Diabetes can be treated and managed by healthful eating, regular physical activity, and medications to lower blood glucose levels. A critical objective in diabetes management is reducing cardiovascular disease risk factors such as high blood pressure, high lipid levels, and tobacco use. Patient education and self-care practices also are important aspects of disease management that help people with diabetes stay healthy 2. Long-standing, nationally endorsed measures exist to measure the process of Diabetes care (e.g. Are patients receiving recommended care?) and the outcomes of care (e.g. is the diabetes well controlled?). These were the first set of measures adopted by PCC. These measures assesses whether patients are receiving guidelinerecommended care to help manage their disease, and assess how well patients are achieving control levels of blood sugar, cholesterol, and blood pressure. Improvement in these areas reduces risks of serious complications and death: Reducing A1c blood test results by one percentage point (e.g., from 8.0 percent to 7.0 percent) reduces the risk of microvascular complications (eye, kidney and nerve diseases) by as much as 40 percent 3 Blood pressure control reduces the risk of cardiovascular disease by as much as 50 percent and the risk of microvascular complications by 33 percent 3 Improved LDL cholesterol control can reduce cardiovascular complications by as much as 50 percent 3 Measure Definitions Annual A1c Test. Percent of eligible patients who had at least one A1c test(s) during the measurement year Annual LDL Cholesterol Test. Percentage of eligible patients who had at least one LDL cholesterol test during the measurement year Excellent A1c Control. Percent of eligible patients with most recent A1c level <7.0% Poor A1c Control. Percent of eligible patients with most recent A1c level >9.0%. If no A1c test was performed during the measurement year, result is considered to be in poor control (Note: Lower rates are better for this measure) Good LDL Control. Percent of eligible patients with most recent LDL cholesterol level < 100 mg/dl BP Control. Percent of eligible patients with most recent BP measurement < 140/80 (In the following graphs, the PCC presents six measures related to Diabetes care. Control of A1c<8% is being reported for the first time in FY 2014, so a graph for that measure is not presented in this report. Instead, we present A1c<7%, an indicator of excellent control.) Diabetes Clinical Performance Clinics have maintained many of the improvements from previous years in diabetes management; meeting or exceeding HEDIS benchmarks in four of the six measures reported. Blood pressure control in diabetes exceeds 90 th percentile performance. Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 5

9 Hypertension (High Blood Pressure) The American Heart Association reports that approximately 1 in 3 Americans have been diagnosed with high blood pressure, but less than half of Americans with high blood pressure have their condition under control. High blood pressure is a condition caused by the increased force of blood flow against artery walls, caused either by constriction of arteries or by an increase in the amount of blood pumped by the heart. Hypertension increases the risk of heart disease, stroke, heart attack, congestive heart failure, and kidney disease. Stage one high blood pressure begins at 140/90 mm Hg. Life expectancy for people with hypertension is approximately 5 years shorter than for people with normal blood pressure. African Americans are at highest risk of hypertension. Hypertension can be managed by taking appropriate medications and incorporating behavioral changes, such as decreasing sodium intake, avoiding tobacco and increasing exercise. Measure Definition Hypertension BP Control. Percent of eligible hypertensive patients with most recent recorded blood pressure measurement < 140/90 Hypertension Clinical Performance Clinics have demonstrated excellent control of hypertension, approaching 90th percentile performance. Cancer Screening The purpose of performing screening exams on otherwise healthy and asymptomatic patients is to identify conditions that carry a high risk of morbidity or mortality, but for which effective treatments are available if caught early. Clear disparities in care exist among minorities and the uninsured in the U.S 1. The Centers for Disease Control and Prevention s Cancer Screening in the U.S note that financial barriers and access to health care account for some of the disparities in cancer screening, but Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 6

10 education levels, age, and length of residence in the U.S. for some immigrant subgroups also have an effect. Lack of health insurance and other barriers prevent many Americans from receiving optimal health care. Uninsured patients and ethnic minorities are substantially more likely to be diagnosed at later stages, when treatment can be more extensive and costly 2. The Medical Directors prioritized cancer screening to be an area of focus in FY Grant funding has supported process improvement efforts, and grants combined with increased county funding have enabled Montgomery Cares to fully fund the projected demand for breast and colorectal cancer screening for the first time since Montgomery Cares program inception. PCC is reporting on three cancer screening process measures: Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening Breast Cancer Screening Other than skin cancer, breast cancer is the most commonly diagnosed cancer among women in the United States 3. It is the second leading cause of cancer deaths in women 3. About 85% of breast cancers occur in women with no family history of the disease. Screening mammography is especially valuable to these women, often detecting breast cancer at an early stage when treatment is less costly, more effective and a cure is more likely 1. Women can reduce their risk of breast cancer by maintaining a healthy diet and healthy weight, regular physical activity, and reducing alcohol consumption. Certain hormonal therapies can increase the risk of breast cancer 3. Measure Definition Breast Cancer Screening. Percent of eligible women years of age with a documented mammogram in the past two years Breast Cancer Screening Clinical Performance Montgomery Cares participating clinics have improved breast cancer screening rates each year, though are not yet achieving targeted performance. Cervical Cancer Screening Cervical cancer screening detects cancerous and pre-cancerous cells. Cervical cancer is the easiest gynecologic cancer to prevent with regular screening tests and follow-up. It also is highly curable when found and treated early 1. For women in whom precancerous lesions were detected through Pap tests, the likelihood of survival is nearly 100% with appropriate care 2. The human papillomavirus (HPV) is the main cause of cervical cancer 1. HPV is a common sexually transmitted virus. HPV vaccination protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers. The vaccine is recommended for pre-teen girls and also recommended for girls and women aged 13 through 26 who did not get any or all of the series of HPV vaccinations when they were younger. Approximately 50% of newly diagnosed invasive cervical cancers in the U.S. are in women who have never had a Pap test, and an additional 10% are in women who have not had a Pap test in the past 5 years 2. In 2010, the prevalence of Pap test use was lowest among older women, women with no health insurance, and recent immigrants 3. Women can reduce their risk of cervical cancer by receiving HPV vaccinations, obtaining regular pap tests and following up on any abnormal results, avoiding smoking, using a condom, and limiting the number of sexual partners. Measure Definition Cervical Cancer Screening. Percent of eligible women between 24 and 64 years of age with a documented pap smear in the past two years Cervical Cancer Screening Clinical Performance Montgomery Cares participating clinics have improved cervical cancer screening rates each year, and are approaching targeted performance. Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 7

11 Colorectal Cancer Screening Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, but it doesn't have to be. Screening can find precancerous polyps abnormal growths in the colon or rectum so they can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage, when treatment often leads to a cure 1. In 2011, African Americans had the highest rate of colorectal cancer, followed by white, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native people 1. With alternative screening modalities and more acceptance of screening, incidence, and mortality rates for colorectal cancer screening have decreased significantly each year between 2001 and Still, 22 million people in the US are not up to date on colorectal cancer screening. Measure Definition Colorectal Cancer Screening. Percent of eligible adults years of age who had appropriate screening for colorectal cancer (includes fecal occult blood test X3 or fecal immunoassay in the past year, or flexible sigmoidoscopy in the past 5 years or colonoscopy in the past 10 years) Colorectal Cancer Screening Clinical Performance Montgomery Cares participating clinics have improved colorectal cancer screening rates in the last two fiscal years, but screening rates remain extremely low. Relevant HEDIS Medicaid benchmarks are not available for comparison. Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 8

12 Appendix I: Measure Definitions Primary Care Coalition of Montgomery County Quality Indicators 2014 Measure Name Denominator Numerator Diabetes Measures Hemoglobin A1c (HbA1c)Testing Poor control of HbA1c Excellent control of HbA1c Control of HbA1c LDL Cholesterol Testing LDL cholesterol control (< 100 mg/dl) Monitoring for Nephropathy Retinal eye exams Denominator patients who had at least one HbA1c test within one year prior to their most recent encounter. Denominator patients who did not have at least one HbA1c test within one year prior to their most recent encounter or whose last HbA1c test was > 9%. Denominator patients who had at least one HbA1c test within one year prior to their post recent encounter and whose last HbA1c test was < 7%. Denominator patients who had at least one HbA1c test within one year prior to their post recent encounter and whose last HbA1c test was < 8%. Denominator patients who had at least one LDL cholesterol test within one year prior to their most recent encounter Denominator patients who had at least one LDL cholesterol test within one year prior to their most recent encounter and whose last LDL cholesterol was <100 mg/dl Denominator patients who had at least one of the following tests within one year prior to their most recent encounter: 24-hour urine protein screening, microalbumin urine screening, microalbumin/creatinine ratio. Denominator patients who received a retinal eye exam from an ophthalmologist or optometrist within one year prior to their most recent encounter. Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 9

13 Foot exams Diabetes Blood pressure control (<140/80) Hypertension Measures Blood pressure measurement Blood pressure control Cancer Screening Measures Breast Cancer Screening 40years Breast Cancer Screening 50years Cervical Cancer Screening Colorectal Cancer Screening hypertension who had two face-to-face hypertension who had two face-to-face Women aged who had two face-toface encounters with different dates of service - one visit during the measurement period and the other visit in the measurement period or within two years prior to the end of the Women aged 50 to 69 who had two face-toface encounters with different dates of service - one visit during the measurement period and the other visit in the measurement period or within two years prior to the end of the Women aged as of the end of the measurement period who had two face-toface encounters with different dates of service - one visit during the measurement period and the other visit in the measurement period or within two years prior to the end of the Men and women ages as of the end of the measurement period who had two faceto-face encounters with different dates of service - one visit during the measurement period and the other visit in the measurement period or within two years prior to the end of the measurement period Denominator patients who received at least one LEAP or general foot exam within one year prior to their most recent encounter. Denominator patients whose blood pressure at their last encounter was <140/80. Denominator patients who had a blood pressure measurement taken at their last encounter Denominator patients whose blood pressure at their last encounter was <140/90. Denominator patients who received a mammogram within two years prior to their most recent encounter. Denominator patients who received a mammogram within two years prior to their most recent encounter. Denominator patients who received a pap smear within three years prior to their most recent encounter. Denominator patients who received one of the following tests: Colonoscopy within ten years prior to their most recent encounter Flexible sigmoidoscopy within five years prior to their most recent encounter Fecal occult blood or FIT test within one year prior to their most recent encounter Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 10

14 References Diabetes 1. Data from the National Diabetes Statistics Report, 2014 (released June 10, 2014) as reported by the American Diabetes Association accessed on December 4, accessed on December 4, Centers for Disease Control and Prevention; Cancer Screening United States, 2010Weekly January 27, 2012 / 61(03); Hypertension 1. accessed December 4, accessed December 4, 2014 Cancer Screening 1. Centers for Disease Control and Prevention; Cancer Screening United States, 2010 Weekly January 27, 2012 / 61(03); American Cancer Society Cancer Facts & Figures 2011 htp:// (February 2012) 3. Cervical Cancer American Cancer Society Cervical Cancer. (June 5, 2013) 3. Business Group Health. Evidence Statement Cervical Cancer Screening. es.pdf (June 7, 2012) Colorectal Cancer 1. Primary Care Coalition Montgomery Cares Clinical Performance Measures, FY 2014 Page 11

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16 Prepared by Approved by Quality Health Improvement Committee January 29, 2015