APPENDIX C CLAIMS DATA SPECIFICATIONS. Item Definition Variable Name Format Claims Data Algorithm NOTES

Transcription

1 APPENDIX C CLAIMS DATA SPECIFICATIONS ASTHMA INDICATOR 02_03: Patients with the diagnosis of moderate-to-severe asthma should have been prescribed a beta2-agonist inhaler for symptomatic relief of exacerbations to use as needed. Emergency room contact for asthma ERASMA* Date All dates on which there was an emergency room visit for the primary diagnosis of asthma (all FROMDATE where DIAG1 = 493 and SITE_CDE=7,8,10) Hopitalizations for asthma IPASMA* Date Prescriptions for asthma medications ASMARX* Date All dates on which there was a hospitalization for the primary diagnosis of asthma (all FROMDATE where DIAG1 = 493 and SITE_CDE=4) All dates on which there is a prescription for asthma medications (all FILLDATE where NDCCODE = see ASMARX list following specifications for asthma measures) ASMARX NDC codes are from NCQA's list of medications that indicate treatment of asthma

2 Outpatient visits for asthma OPASMA* Date All dates on which there was an outpatient visit for asthma (all FROMDATE where any DIAG* = 493 and SITE_CDE=1) Evidence of moderate to severe asthma during first year of study MODSEVAS 1=yes;0=no Evidence of moderate to severe asthma if any of the following are true:(1) at least 4 asthma medication dispensing events (4 unique dates for ASMARX*) in first year of study (ELIGBEG to ELIGBEG + 12 months)or(2) at least 1 ER visit for asthma in first year of study (ERASMA* < ELIGBEG + 12 months)or(3) at least 1 hospitalization for asthma in first year of study (IPASMA* < ELIGBEG + 12 months)or(4) at least 4 asthma visits in first year of study (4 unique dates for OPASMA* that are between ELIGBEG to ELIGBEG + 12 months) AND at least 2 asthma medication dispensing events (2 unique dates for ASMARX* that are between ELIGBEG to ELIGBEG + 12 months)

3 Eligible for 02_03 (diagnosis of moderate to severe asthma) E02_03 1=yes;0=no Eligible if MODSEVAS = 1 Using HEDIS algorithm and 1st year of data to identify asthma severity, therefore only scoring on care delivered during the 2nd year of the study. Prescription for beta2-agonist inhaler ordered BETAINH 1=yes;0=no Any prescription during 2nd year of study for beta2-agonist (any FILLDATE where FILLDATE >= 1/1/1999 and NDC = see BETAINH list at the end of specifications for asthma measures) Pass 02_03 (beta2- agonist inhaler prescribed) S02_03 1=yes;0=no Pass if BETAINH = 1 Beta2-agonist list derived from the multum ndc_denorm table, medications were selected if route=inhaled and active ingredients = Albuterol, Bitolterol, Epinephrine, Isoetharine, Isoproterenol, Metaproterenol, Pirbuterol, Racepinepine

4 INDICATOR 02_05: Patients with moderate-to-severe asthma should not receive beta-blocker medications (e.g., atenolol, propranolol). Eligible for 02_05 (diagnosis of moderate to severe asthma, where severity can be estimated with encounter and medication information) E02_05 1=yes;0=no Eligible if MODSEVAS = 1 Using 1st year of data to identify asthma severity, therefore only scoring on care delivered during the 2nd year of the study. Prescription for betablocker medication ordered BETABLK 1=yes;0=no Any prescription for betablockers during the second year of the study (any FILLDATE > ELIGBEG + 12 months where NDCCODE = corresponds to code on BETABLK worksheet) Pass 02_05 (NO prescription for a beta-blocker) S02_05 1=yes;0=no Pass if BETABLK=0 Beta blocker list derived from the multum ndc_denorm table, medications were selected if route=oral and active ingredients = Acebutolol, Atenolol, Betaxolol, Bisoprolol, Carteolol, Metoprolol, Nadolol, Penbutolol, Pindolol, Propranolol, Sotalol, Timolol

5 INDICATOR 02_06: Patients requiring chronic treatment with systemic corticosteroids during any 12 month period should have been prescribed inhaled corticosteroids during that same 12 month period. Oral corticosteroid prescriptions POCORT* Date All prescription dates for oral coritcosteroids (all FILLDATE where NDCCODE corresponds to code in the POCORT file listed at the end of the claims data specifications) Oral corticosteroid list derived from the multum ndc_denorm table, medications were selected if route=oral and active ingredients = aminoglutethimide, betamethasone, cortisone acetate, dexamethasone, fludrocortisone acetate, fluphenazine, hydrocortisone, methylprednisolone, prednisolonse, presnisolone sodium phosphate, prednisone, triamcinolon

6 Chronic treatment with systemic corticosteroids CHRNCORT 1=yes;0=no Eligible for 02_06 (chronic treatment with systemic corticosteroids) E02_06 1=yes;0=no At least 1 prescription for oral corticosteroids during the study that was for at least 28 days (any POCORT* where DAY_SPLY>=28) OR at least 2 tapers within 12 months (2 or more POCORT* within 12 months where DAY_SPLY < 28 days) Eligible if CHRNCORT=1 and MODSEVAS=1 Prescription for inhaled corticosteroids ordered INHCORT 1=yes;0=no Any prescription for inhaled coritcosteroids (any FILLDATE where NDCCODE corresponds code on INHCORT file listed at the end of the specifications for asthma measures) Inhaled corticosteroid list derived from the multum ndc_denorm table, medications were selected if route=inhaled and active ingredients = beclomethasone dipropionate, budesonide, flunisolide, flucticasone proprionate, triamcinolone acetonide

7 Pass 02_06 (prescription for inhaled corticosteroids) S02_06 1=yes;0=no Pass if INHCORT = 1 INDICATOR 02_07: Patients on chronic theophylline (dose > 600 mg/day for at least 6 months) should have at least one serum theophylline level determination per year. Dates of prescriptions for theophylline THEO* Date Daily dose of theophylline DDTHEO* Continuous Earliest date where theophylline was > 600 mg/day GT600 Date All dates (FILLDATE) where a prescription for theophylline was filled (NDCCODE = see THEO file listed at the end of the asthma specifications) The daily dose for each theophylline prescription (for each FILLDATE that equals THEO*, daily dose = ((DRUG_STR * QTY_DRUG)/DAY_SPLY) Earliest date where theophylline was > 600 mg/day (Min(THEO* where DDTEHO* >600)) Theophylline list derived from the multum ndc_denorm table, medications were selected if route=oral and active ingredients = theophylline

8 Eligible for 02_07 (Daily dose of theophylline) E02_07 1=yes;0=no Theophllyine level checked THELVL* Date Pass 02_07 (theophylline level checked) S02_07 1=yes;0=no Eligible if high theophllyine dose in first year of study (GT600 <= (ELIGBEG + 12 months)) AND MODSEVAS=1 All dates on which the patient's theophylline level was checked (all CPTDATE where CPTCODE = and all FROMDATE where PROC1-6=80198) Pass if theophllyine level checked within 1 year of high dose (GT600 < any THELVL* <= (GT months)) INDICATOR 02_17: Patients admitted to the hospital for asthma exacerbation should have oxygen saturation measured. All dates on which there was a hospitalization for the primary Hopitalizations for asthma IPASMA* Date diagnosis of asthma (all FROMDATE where DIAG1 = 493 and SITE_CDE=4) Eligible for 02_17 (admitted to the hospital for asthma exacerbation) E02_17* 1=yes;0=no Eligible if IPASMA*<>NA

9 Oxygen saturation measured during Oxygen saturation measured O2SAT* Date asthma hospitalization (PROC*= ) Pass 02_17 (oxygen saturation measured during the hospitalization) S02_17* 1=yes;0=no Pass if any O2SAT* = IPASMA* INDICATOR 02_24: Patients with a hospitalization for asthma exacerbation should receive outpatient follow-up contact within 14 days. Hopitalizations for asthma IPASMA* Date All dates on which there was a hospitalization for the primary diagnosis of asthma (all FROMDATE where DIAG1 = 493 and SITE_CDE=4) Discharge date for asthma Discharge date for asthma ASMADC* Date hospitalizations (the THRUDATE corresponding to each IPASMA*) Eligible for 02_24 (patient hospitalized for asthma) E02_24* 1=yes;0=no Eligible if IPASMA*<>NA

10 Outpatient visits for asthma OPASMA* Date Pass 02_24 (asthma follow-up within 14 days of discharge) S02_24 1=yes;0=no All dates on which there was an outpatient visit for asthma (all FROMDATE where any DIAG* = 493 and SITE_CDE=1) Pass if outpatient visit for asthma within 14 days of discharge (ASMADC* < any OPASMA* <= (ASMADC* + 14 days))

11 CORONARY ARTERY DISEASE Diagnosis codes for ICD9 codes are under the ischemic heart CAD CADDX DIAG*: 410xx-414xx disease section REVCODE: 49x, 50x, 51x, 52x, 53x, 76x, 82x, 83x, 84x, 85x, 88x, 92x, 94x, 96x, 972, 973, 974, 975, 976, 977, 978, 979, 982, 983, 984, 985, 986, 988, 989 Encounter codes (outpatient/non-acute inpatient) OUTPT CPT: , , , , , , , , , , REVCODE: 45x, 981 Encounter codes (ER) ER Encounter codes (acute inpatient) IP CPT: REVCODE: 10x-16x, 20x-22x, 72x, 80x, 987 CPT: , , , , , ,

12 New diagnosis of CAD (flag) NEWCAD 1=yes;0=no New diagnosis of CAD (date) NEWCADDT DATE Prior CAD (flag) CADPREV 1=yes;0=no First CAD visit date FSTCADVS DATE At least 2 outpatient or inpatient encounters (codes above) where there was a diagnosis for CAD (DIAG*= ) and the earliest FROMDATE with the diagnosis code is during the 2nd year of the study (on or after 1/1/1999). If NEWCAD=1, then NEWCADDT is the earliest FROMDATE where there is a diagnosis of CAD and one of the above encounter codes. At least 2 outpatient or inpatient encounters (codes above) where there was a diagnosis for CAD (DIAG*= ) and the earliest FROMDATE with the diagnosis code is during the 1st year of the study (on or before 12/31/1998). If CADPREV=1 (& NEWCAD=0), then FSTCADVS is the earliest from date where there is a diagnosis of CAD (DIAG*=410xx-414xx) and one of the above encounter codes (for any setting)

13 INDICATOR 11_01: Patients newly diagnosed with CAD should receive aspirin (at a dose of at least 81 mg/day continued indefinitely) within one week of the diagnosis of CAD unless they have a contraindication to aspirin. Bleeding or transfusion (CI to aspirin) BLDASA* Date(s) Eligible for 08_01 (new CAD diagnosis and aspirin not contraindicated) E11_01 1=yes;0=no Aspirin prescribed ASARX* Date(s) ICD9 codes 578 are for All FROMDATE/CPTDATE where any of gastrointestinal the following are true: bleeding; CPT DIAG*=578xx and ICD9 Proc 990x are PROC* or CPTCODE=36430, 990X for transfusions Eligible if new CAD diagnosis (NEWCADDT<>NA) and No bleeding or transfusions on or within 4 weeks prior to new CAD diagnosis (no BLDASA* between NEWCADDT-4 weeks and NEWCADDT) The NDC codes for aspirin came from the dnorm_ndc table in the multum database; all oral meds with "aspirin" as active ingredient were All dates (FILLDATE) on which a selected; the list prescription (NDCCODE) for aspirin includes combination was dispensed (see aspirin file medications that would list at the end of the CAD measure not typically be specifications) prescribed for CAD.

14 Pass 11_01 (patient offered aspirin within 1 week of CAD diagnosis) S11_01 1=yes;0=no Pass if any ASARX* is on or within 1 week after NEWCADDT (NEWCADDT<=ASARX*<=(NEWCADDT+7days )) INDICATOR 11_02: Patients with a prior diagnosis of CAD who are not on aspirin and do not have contraindications to aspirin should receive aspirin (at a dose of at least 81 mg/day continued indefinitely) within one week of any visit to a provider in which CAD was addressed. Aspirin prescription filled ASARX* DATE(s) Bleeding or transfusion (CI to aspirin) BLDASA* Date(s) The NDC codes for aspirin came from the dnorm_ndc table in the multum database; all oral meds with "aspirin" as active ingredient were All dates (FILLDATE) on which a selected; the list prescription (NDCCODE) for aspirin includes combination was dispensed (see aspirin file medications that would list at the end of the CAD measure not typically be specifications) prescribed for CAD. All FROMDATE where any of the following are true: DIAG*=578xx PROC*=36430, 990X ICD9 codes 578 are for gastrointestinal bleeding; CPT and ICD9 Proc 990x are for transfusions

15 Eligible for 1_02 (prior diagnosis of CAD and not on aspirin and no contraindications to aspirin) 11_02 1=yes;0=no Aspirin prescribed ASARX* DATE(s) Pass 11_02 (patient offered aspirin within one week of CAD visit) 11_02 1=pass;0=fail Eligible if visit for CAD in 1st year, no aspirin prescription prior to the CAD visit and no bleeding within 4 weeks on or prior to the CAD visit: FSTCADVS<>NA and (ASARX*=NA or ASARX* >= FSTCADVS) and (No BLDASA* on or between FSTCADVS-4 weeks and FSTCADVS) The NDC codes for aspirin came from the dnorm_ndc table in the multum database; all oral meds with "aspirin" as active ingredient were All dates (FILLDATE) on which a selected; the list prescription (NDCCODE) for aspirin includes combination was dispensed (see aspirin file medications that would list at the end of the CAD measure not typically be specifications) prescribed for CAD. Pass if any aspirin prescribed within a week of CAD visit (FSTCADVS <= ASARX*<= FSTCADVS+7 days)

16 INDICATOR 14: Patients discharged after an acute myocardial infarction who do not have contraindications to aspirin should be discharged on aspirin at a dose of at least 81 mg/day. Discharge date for AMI hospitalization AMIDSCH DATE Bleeding or transfusion (CI to aspirin) BLDASA* Date(s) Eligible for 08_14 (discharged for AMI and aspirin not contraindicated) E11_14 1=eligible; 0=not eligible Aspirin prescribed ASARX* DATE(s) Pass 08_14 (patient offered aspirin at S11_14 1=pass;0=fail Discharge date (THRUDATE) where there was a diagnosis of AMI (any DIAG*=410xx) and SITE_CDE=4 and Reveune/CPT codes for inpatient stay (codes listed prior to indicators) **FACILITY FILE ONLY** All FROMDATE/CPTDATE where any of the following are true: DIAG*=578xx PROC*/CPTCODE=36430, 990X Eligible if discharged for an AMI (AMIDSCH<>NA) and no bleeding/transfusion in past for weeks (No BLDASA* on or between AMIDSCH- 4 weeks and AMIDSCH) ICD9 codes 578 are for gastrointestinal bleeding; CPT and ICD9 Proc 990x are for transfusions The NDC codes for aspirin came from the dnorm_ndc table in the All dates (FILLDATE) on which a multum database; all prescription (NDCCODE) for aspirin oral meds with was dispensed (see aspirin file "aspirin" as active list at the end of the CAD measure ingredient were specifications) selected Pass if any ASARX* is within 1 week on or after AMIDSCH

17 discharge) INDICATOR 15: Patients discharged after an acute myocardial infarction should be discharged on a beta-blocker (unless they have contraindications to beta-blockers). Discharge date for AMI hospitalization AMIDSCH DATE Diagnostic contraindications to beta blocker CONDXBET 1=yes;0=no Discharge date (THRUDATE) where there was a diagnosis of AMI (any DIAG1=410xx) and SITE_CDE=4 and REVCODE or PROC* for inpatient stay (codes listed above prior to indicators) **FACILITY FILE ONLY** Any FROMDATE on or prior to the AMI discharge (AMIDSCH) where any DIAG*= CI to beta blockers 250.x1, 250.x3, 493, 426.0, from HEDIS. ICD , , 426.2, 426.3, codes are for insulin 426.4, , , , dependent diabetes, , 426.7, , , ashtma, heart block > , , , , 1 degree, sinus , , , , braycardia, heart , , 428.0, 428.1, failure, left , , 492.0, 492.8, 496, ventricular 518.2, dysfunction, COPD

18 Precription for a medication that treats a condition that contraindicates beta blockers CONRXBB 1=yes;0=no Eligible for 1_15 (discharged for AMI and beta blockers not contraindicated) E11_15 1=eligible; 0=not eligible Beta blocker prescription dates BBRX* DATE(s) Pass 11_15 (patient offered beta blocker at discharge) S11_15 1=pass; 0=fail Medications that treat diagnoses that Any prescription (FILLDATE) within contraindicate beta 7 days after or anytime on or blockers are: asthma prior to the AMI discharge meds (inhaled (AMIDSCH) for a medication that corticosteroids and would contraindicate beta blockers leukotriene (see list at the end of antagonists) and specifications of CAD measures) insulin Eligible if discharged for an AMI at least 60 days into study and at least 7 days prior to the end (ELIGBEG + 60 <= AMIDSCH <= ELIGEND - 7 days) and there are no contraindications to beta blockers (CONDXBET=0 and CONRXBB=0) All prescription dates (FILLDATE) where NDCCODE for a beta-blocker (see beta-blocker list at the end of the CAD specifications) Pass if any beta-blocker prescription (BBRX*) within 60 days prior to or 7 days after the AMI discharge (AMIDSCH) NDC codes are from Multum's ndc_dnorm table and includes all oral meds where active ingredient was: acebutolol, atenolol, betaxolol, bisoprolon, carteaolol, labetalol, metoprolol, nadolol, penbutolol, pindolol, propranolol, satalol, timolol

19 INDICATOR 11d_03: Patients with newly diagnosed CAD should have a 12-lead ECG at the time of diagnosis Eligible for 11d_03 (new diagnosis of CAD) E11d_03 1=eligible; 0=not eligible 12-lead ECG performed ECGDT* DATE(s) Pass 11d_03 (12-lead ECG offered within 2 days before or after new CAD diagnosis) S11d_03 1=pass;0=fail Eligible if first diagnosis of CAD is in 2nd year of study (NEWCADDT<>NA) All FROMDATE/CPTDATE where any PROC*/CPTCODE = , 8952 Pass if any ECG was performed (ECGDT*) on or within 2 days prior to or 2 days after the initial CAD visit (NEWCADDT) INDICATOR 11d_04A: Patients newly diagnosed with any of the conditions listed below should have a hemoglobin and/or hematocrit measured at the time of diagnosis: a. Stable Angina; New diagnosis of stable angina NEWANG DATE Eligible for 11_04A (new diagnosis of 1=eligible;0=n angina) E11d_04A ot eligible New diagnosis of stable angina if the first diagnosis occurs in months of the study Min FROMDATE where DIAG1=413.xx and (1/1/1999<=FROMDATE<12/1/1999) Eligible if new diagnosis of stable angina (NEWANG<>NA) and diagnosis was made during an As an attempt to isolate new diagnoses of angina, I have only accepted cases where the 1st diagnosis is in the 2nd year of the study.

20 office visit (SITE_CDE=1) Hemoglobin/hematocrit tested HEMTST* DATE(s) Pass 11d_04A (hemoglobin and/or hematocrit measured within 2 days before or after new diagnosis of angina) S11d_04A 1=pass;0=fail All CPTDATE where CPTCODE and all FROMDATE where PROC* = 85013, Pass if any HEMTST* is on or within 3 months prior to or 1 month after new angina dx (NEWANG) INDICATOR 11d_04B: Patients newly diagnosed with any of the conditions listed below should have a hemoglobin and/or hematocrit measured at the time of diagnosis: unstable angina OR MI Hospitalization for unstable angina or MI IPANGMI DATE From hospital file: Earliest date patient admitted to hospital with unstable angina or MI as primary dx (FROMDATE where SITE_CDE=4 and DIAG1=410xx or and REVCODE/PROC* for inpatient stay) **FACILITY FILE ONLY** For angina, I have only include 411.1, which provides unstable in its list of diagnoses, should look to see if people are admitted for angina pectoris (413.xx) and if those codes should be included.

21 Eligible for 11d_04B (new diagnosis of 1=Eligible; Eligible if patient hospitalized unstable angina) E11d_04B 0=not eligible for MI or angina (IPANGMI<>NA) Hemoglobin/hematocrit tested HEMTST* DATE(s) Pass 11d_04B (hemoglobin and/or hematocrit measured within 1 day before or after new diagnosis of unstable angina) S11d_04B 1=pass;0=fail All CPTDATE where CPTCODE and all FROMDATE where PROC* = 85013, Pass if any HEMTST* is on or between 1 day prior to and 1 day after the hospitalization Could not ID a ICD-9 proc code The date associated with the blood work will probably be the admission date (FROMDATE) and equal to IPANGMI INDICATOR 11d_5E: Patients being evaluated for "unstable angina" or "rule out unstable angina" should have an examination at the time of evaluation documenting all of the following: a 12- lead ECG. Earliest date where primary diagnosis was unstable angina (FROMDATE where DIAG1=411.1) Presenting with unstable angina USANG DATE **any encounter type OK, look in FACILITY and DOCTOR files) Eligible for 11d_05E (presenting with unstable angina) E11d_05E 1=eligible;0=n o eligible Eligible if USANG<>NA All FROMDATE/CPTDATE where any 12-lead ECG performed ECGDT* DATE(s) PROC*/CPTCODE = , 8952

22 Pass 11d_05E (12-lead ECG performed at presentation with unstable angina) S11d_05E 1=pass;0=fail Pass if any ECG done on the day patient presented with unstable angina (ECGST* = USANG) INDICATOR 11d_06: Patients admitted with unstable angina should be placed on cardiac monitoring (i.e., telemetry). Earliest date where patient was admitted for unstable angina FROMDATE where SITE_CDE=4 and DIAG1=411.1 and REVCODE/PROC* for Date of unstable angina admission IPUSDT DATE inpatient stay) **FACILITY FILE ONLY** Eligible for 11d_06 (admitted for unstable angina) E11d_06 1=eligible;0=n ot eligible Eligible if IPUSDT<>NA Patient placed on cardiac monitoring TELEM DATE Date (FROMDATE) where patient was admitted to the coronary care unit (REVCODE=21x) on or between admission and discharge for unstable angina Pass 11d_06 (patient placed on cardiac monitoring) S11d_06 1=pass;0=fail Pass if TELEM <> NA INDICATOR 11d_08: Patients admitted with unstable angina should have a repeat ECG hours after admission.

23 Date of unstable Earliest date where patient was admitted for unstable angina FROMDATE where SITE_CDE=4 and DIAG1=411.1 and REVCODE/PROC* for inpatient stay) **FACILITY FILE angina admission IPUSDT DATE ONLY** Eligible for 11d_08 (admitted for unstable angina) 11d_08 1=eligible;0=n ot eligible Eligible if IPUSDT<>NA 12-lead ECG performed ECGHOSP 1=yes;0=no 2 or more codes for an ECG during unstable angina hospitalization (PROC*/CPTCODE = , 8952) Pass 11d_08 (12-lead ECG repeated hours after admission) 11d_08 1=pass;0=fail Pass if ECGHOSP=1 NOTE - cannot specify date/time that ECG occurred during the hospitalization INDICATOR 11d_09A: Patients admitted with unstable angina who have any one of the conditions below should have a measurement of LVEF by echocardiogram, radionuclide scan, or ventriculogram during their hospitalization or within 10 days of discharge unless a prior LVEF is documented in the past year: a history of prior MI;

24 Date of unstable Earliest date where patient was admitted for unstable angina FROMDATE where SITE_CDE=4 and DIAG1=411.1 and REVCODE/PROC* for inpatient stay) **FACILITY FILE angina admission IPUSDT* DATE ONLY** History of MI if any MI diagnosis prior to unstable angina admission History of prior MI MIHX* 1=yes;0=no LVEF measured LVEF* DATE(s) Eligible for 11d_09A (admitted for unstable angina and has history of AMI) 1=eligible;0=n ot eligible E11d_09A Pass 11d_09A (LVEF measured during or within 10 days after admission for unstable angina) S11d_09A 1=pass;0=fail any FROMDATE < IPUSDT* where any DIAG*=410xx All CPTCODE or PROC* where: CPT codes are: 78414, , , , , ICD-9 procedure codes: 8872, Eligible if unstable angina visit in 2nd year of study, a prior history of MI and no LVEF measurement in prior 12 months (IPUSDT*>ELIGBEG+ 12 months) and MIHX*=1 and (no LVEF* between IPUSDT*-12months and IPUSDT*-1day) Pass if any LVEF* is on or within 10 days after IPUSDT ICD9 codes will only be in the PROC* field (not CPTCODE field)

25 INDICATOR 11d_9C: Patients admitted with unstable angina who have any one of the conditions below should have a measurement of LVEF by echocardiogram, radionuclide scan, or ventriculogram during their hospitalization or within 10 days of discharge unless a prior LVEF is documented in the past year: cardiomegaly Date of unstable angina admission IPUSDT* DATE cardiomegaly CRDMEG* 1=yes;0=no LVEF measured LVEF* DATE(s) Earliest date where patient was admitted for unstable angina FROMDATE where SITE_CDE=4 and DIAG1=411.1 and REVCODE/PROC* for inpatient stay) **FACILITY FILE ONLY** Diagnosis of cardiomegaly during unstable angina admission (Any DIAG*=429.3 on IPUSDT*) All CPTCODE or PROC* where: CPT codes are: 78414, , , , , ICD-9 procedure codes: There are other ICD-9 codes that include cardiomegaly, but they have other diagnoses in them as well: congenital glycogen hypertensive ICD9 codes will only be in the PROC* field (not CPTCODE field)

26 , Eligible for 11d_09C (admitted for unstable angina and has cardiomegaly) 1=eligible;0=n ot eligible E11d_09C Pass 11d_09C (LVEF measured within during the hospitalization or within 10 days after discharge for unstable angina) S11d_09C 1=pass;0=fail Eligible if unstable angina visit in 2nd year of study, cardiomegaly presenti and no LVEF measurement in prior 12 months (IPUSDT*>ELIGBEG+ 12 months) and CRDMEG*=1 and (no LVEF* between IPUSDT*-12months and IPUSDT*-1day) Pass if any LVEF* is during the hospitalization or within 10 days after discharge (IPUSDT<= any LVEF*<= THRUDATE+10days)

27 INDICATOR11d_9d: Patients admitted with unstable angina who have any one of the conditions below should have a measurement of LVEF by echocardiogram, radionuclide scan, or ventriculogram during their hospitalization or within 10 days of discharge unless a prior LVEF is documented in the past year: a diagnosis of heart failure. Date of unstable angina admission IPUSDT* DATE(s) Earliest date where patient was admitted for unstable angina FROMDATE where SITE_CDE=4 and DIAG1=411.1 and REVCODE/PROC* for inpatient stay) **FACILITY FILE ONLY** Heart failure diagnosis HFHOSP* 1=yes;0=no LVEF measured LVEF* DATE(s) Diagnosis of heart failure during unstable angina admission any DIAG*= 428.xx, , 402.x1, 404.x1, 404.x3, 425.4x, 425.5x where FROMDATE=IPUSDT* All CPTCODE or PROC* where: CPT codes are: 78414, , , , , ICD-9 procedure codes: 8872, ICD9 codes will only be in the PROC* field (not CPTCODE field)

28 Eligible for 11d_09d (admitted for unstable angina and diagnosis of heart failure) 1=eligible;0=n ot eligible E11d_09D Pass 11d_09D (LVEF measured within 1 year prior or 10 days after admission for unstable angina) S11d_09D 1=pass;0=fail Eligible if unstable angina hospitalization in 2nd year of study, diagnosis of heart failure during hospitalization and no LVEF measurement in prior 12 months (IPUSDT*>ELIGBEG+ 12 months) and HFHOSP*=1 and (no LVEF* between IPUSDT*-12months and IPUSDT*-1day) Pass if any LVEF* is during the hospitalization or within 10 days after discharge (IPUSDT<= any LVEF*<= THRUDATE+10days) INDICATOR 11d_12: Patients hospitalized with an MI should have an assessment of LVEF prior to discharge if they have any risk factors for low LVEF (unless it is noted during hospitalization that prior to admission LVEF was <=40%). All dates where patient was admitted for AMI FROMDATE where SITE_CDE=4 and DIAG1=410xx and REVCODE/PORC* for Admitted for AMI AMIIP* DATE(s) inpatient stay

29 Heart failure diagnosis HFAMI* 1=yes;0=no Cardiomegaly diagnosis CARAMI* 1=yes;0=no Pulmonary congestion or edema diagnosis LUNG* 1=yes;0=no Eligible for 11d_12 (admitted for AMI and has risk for low LVEF -- HF, cardiomegally, pulmonary congestion or edema) E11d_12 1=eligible;0=f ail LVEF measured LVEF* DATE(s) Diagnosis of heart failure during AMI admission any DIAG*= 428.xx, , 402.x1, 404.x1, 404.x3, 425.4x, 425.5x where FROMDATE=AMIIP** Diagnosis of cardiomegaly during AMI admission any DIAG*=429.3 where FROMDATE=AMIIP* Diagnosis of pulmonary congestion or edema during AMI admission: any other DIAG*=486, 506.1, 514, 518.4, Eligible if admitted for AMI and has a risk factor for low LVEF AMIIP*<>NA and (HFAMI*=1 or CARAMI*=1 or LUNG*=1) All CPTCODE or PROC* where: CPT codes are: 78414, , , , , ICD-9 procedure codes: 8872, There are other ICD-9 codes that include cardiomegaly, but they have other diagnoses in them as well: congenital glycogen hypertensive ICD9 codes will only be in the PROC* field (not CPTCODE field)

30 Pass 11d_12 (LVEF measured prior to discharge or noted to be <= 40%) S11d_12 1=pass;0=Fail Pass if LVEF measured during hospitalization any LVEF*=on ore between AMIIP* and corresponding discharge data INDICATOR 11_13: Patients hospitalized with an MI who have a history of prior MI, but no risk factors for low LVEF, should have an assessment of LVEF during the hospitalization or within 2 weeks of discharge (unless it is noted during hospitalization that prior to admission LVEF was <=40%). All dates where patient was admitted for AMI FROMDATE where SITE_CDE=4 and DIAG1=410xx and REVCODE/PORC* for Admitted for AMI AMIIP* DATE(s) inpatient stay Diagnosis of AMI prior to AMI admission History of AMI AMIHX* 1=yes;0=no Heart failure diagnosis HFAMI* 1=yes;0=no any DIAG*=410xx where FROMDATE < AMIIP* Diagnosis of heart failure during AMI admission any DIAG*= 428.xx, , 402.x1, 404.x1, 404.x3, 425.4x, 425.5x where FROMDATE=AMIIP**

31 Cardiomegaly diagnosis CARAMI* 1=yes;0=no Pulmonary congestion or edema diagnosis LUNG* 1=yes;0=no Eligible for 11d_13 (admitted for AMI and has a history of AMI and no risk factors for low LVEF -- HF, cardiomegally, pulmonary congestion or edema) E11d_13 1=eligible;0=n ot eligible LVEF measured LVEF* DATE(s) Diagnosis of cardiomegaly during AMI admission any other DIAG*=429.3 where FROMDATE=AMIIP* Diagnosis of pulmonary congestion or edema during AMI admission: any other DIAG*=486, 506.1, 514, 518.4, Eligible if admitted for AMI during 2nd year of study, have a history of AMI and no risk factors for low LVEF AMIIP*>=(ELIGBEG + 12 months) and AMIHX*=1 and HFAMI*=0 and CARAMI*=0 and LUNG*=0 All CPTCODE or PROC* where: CPT codes are: 78414, , , , , ICD-9 procedure codes: 8872, There are other ICD-9 codes that include cardiomegaly, but they have other diagnoses in them as well: congenital glycogen hypertensive ICD9 codes will only be in the PROC* field (not CPTCODE field)

32 Pass 11d_13 (LVEF measured prior to discharge or within 2 weeks of discharge or LVEF noted to be <= 40%) S11d_13 1=pass;0=fail Pass if LVEF measured during hospitalization or within 2 weeks of discharge (AMIIP*<=LVEF*<=THRUDATE of hospitalization + 2 weeks) INDICATOR 11d_14: Patients < 75 years old with an MI should be offered symptom-limited stress testing or coronary angiography within 8 weeks of the MI (unless they have contraindications to revascularization). All dates where patient was admitted for AMI: FROMDATE where SITE_CDE=4 and DIAG1=410xx and Admitted for AMI AMIIP* DATE(s) REVCODE/PORC* for inpatient stay Discharged for AMI AMIDCH* DATE(s) Discharge date from AMI hospitalization THRUDATE where FROMDATE=AMIIP* age at MI hospitalization Age MIAGE* continuous Diagnosis of a malignancy (CI to revascularization) AMIMAL* 1=yes;0=no AMIIP*-DOB (from enrollment file) Any diagnosis of malignancy during or prior to AMI hospitalization any DIAG*= where FROMDATE<=AMIIP*

33 Diagnosis of severe COPD (CI to revascularization) AMICOP* 1=yes;0=no Diagnosis of AIDS (CI to revascularization) AMIAID* 1=yes;0=no Diagnosis of hepatic cirrhosis (CI to revascularization) AMICIR* 1=yes;0=no Stroke within month prior to reduced LVEF (CI to revascularization) AMISTK* 1=yes;0=no Digitalis intoxication (CI to revascularization) AMIDIG* 1=yes;0=no Progressive renal insufficiency (CI to revascularization) AMIREN* 1=yes;0=no Any diagnosis of COPD during AMI hospitalization any DIAG*=4912x, 492xx, 4932x, 494xx, 495xx, 496xx where FROMDATE=AMIIP* Any diagnosis of AIDS during or prior to the AMI hospitalization any DIAG*=042 where FROMDATE<=AMIIP* Any diagnosis of cirrhosis of liver during AMI hospitalization any DIAG*=571.2, 571.5, 571.6=AMIDT* Any strike/acute CVD during or within 1 month prior to AMI hospitalization any DIAG*= where ((AMIIP*-1 month) <=FROMDATE <=AMIIP*) Digitalis intoxication diagnosed during the AMI hospitalization any DIAG*=972.1 where FROMDATE=AMIIP* Any diagnosis of renal insufficiency during the hospitalization any DIAG*=593.9 where FROMDATE=AMIIP*

34 Active gastrointestinal bleeding (CI to revascularization) AMIGI* 1=yes;0=no Active infection, sepsis or fever due to infection (CI to revascularization) AMIINF* 1=yes;0=no GI bleeding during AMI admission any other DIAG*=578xx where FROMDATE=AMIIP* I have included ICD9 codes for everything under the "Other Bacterial Diseases" Any bacterial infection during the heading -- probably AMI hospitalization any other overly inclusive and DIAG*= where may exclude people FROMDATE=AMIIP* from eligibility Two or more CABS PRIOR to AMI hospitalization Two or more prior CABS operations (CI to revascularization) PRICAB* Eligible for 11d_14 (admitted for AMI, less than 75 years and no contraindications to revascularization) E11d_14* 1=yes;0=no 1=eligible;0=f ail 2 or more FROMDATE<AMIDI* where PROC*= , , , , 361x, 362x Eligible if less than 75 discharged from AMI hospitalization at least 8 weeks prior to ELIGEND and have no CI to revascualrization: AMIDCH*<(ELIGEND - 8 weeks) and AMIAGE<75 and AMIMAL*=0 and AMICOP*=0 and AMIAID*=0 and AMICIR*=0 and AMISTK*=0 and AMIDIG*=0 and AMIREN*=0 and AMIGI* and AMIINF*=0 and PRICAB*=0

35 Coronary catheterization performed during AMI hospitalization or within 8 weeks after discharge from doctor or facility: any PROC* or CPTCODE= where (AMIDT*<= FROMDATE<=AMIDCH*+8weeks) OR from facility file: any PROC* Coronary angiography performed ANGIOG* 1=yes;0=no = where (AMIDT*<= FROMDATE<=AMIDCH*+8weeks) Stress test performed during AMI hospitalization or within 8 weeks after discharge from doctor or facility: any PROC* or CPTCODE= , where (AMIDT*<= FROMDATE<=AMIDCH*+8weeks) OR Stress test performed STRTST* 1=yes;0=no Pass 11d 14 (coronary angiography or stress test offered within 8 weeks for MI) S11d_14* 1=pass; 0=fail from facility file: any PROC* = where (AMIDT*<= FROMDATE<=AMIDCH*+8weeks) Pass if coronary angiography or stress test performed during AMI hospitalization or within 8 weeks post discharge ANGIOG*=1 or STRTST*=1

36 DIABETES Identifying Diabetics Diagnosis and encounter/revenue codes are listed in the 3 rows below to define a flag for diabetics. Flag for diagnosis of diabetes DIABFL 1=yes; 0=no Diagnosis of Type 1 or Type 2 diabetes Set flag to 1 if: (1) diagnosis of diabetes coded on at least 2 DIFFERENT dates of service in an ambulatory setting or non-acute inpatient setting OR (2) diagnosis of diabetes on at least 1 face-to-face encounter in an acute inpatient or emergency room setting Any of the following ICD-9 diagnosis codes - DIAG*: 250.xx= diabetes mellitus 357.2x= neuropathy in diabetes 362.0x= diabetic retinopathy = diabetic cataract Exclude if : 648.8x= gestational diabetes

37 Encounter in an ambulatory setting or non-acute inpatient setting Acute inpatient/er encounter Revenue codes (REVCODE) on date where diagnosis (see above codes) was for diabetes: 49X-53X, 55X-59X, 65X, 66X, 76X, 82X-85X, 88X, 92X, 94X, 96X, , , 988, 989 OR CPT codes: , , , , , , , , , , , , 99411, 99412, , Revenue codes (REVCODE): 10X-16X, 20X-22X, 45X, 72X, 80X, 981, 987 OR CPT codes: , , , , , , , INDICATOR 13_02A: Patients with the diagnosis of Type 1/Type 2 diabetes should have all of the following: a. Glycosylated hemoglobin or fructosamine every 6 months.

38 Eligible for 13_02A (diagnosis of Type 1/Type 2 diabetes) E13_02A 1=yes;0=no DIABFL =1 Dates of glycosylated hemoglobin or fructosamine tests DIABBLD DATE Pass 13_02A (Glycosylated hemoglobin or fructosamine tested every 6 months) S13_02A 1=yes;0=no All FROMDATE where CPTCODE or PROC* =83036 At least 3 HbA1c tests (DIABBLD) 90 days apart INDICATOR 13_02B: Patients with the diagnosis of Type 1 or Type 2 diabetes should have all of the following: b. Eye and visual exam (annual). Eligible for 13_02B (diagnosis of Type 1 or Type 2 diabetes) E13_02B 1=yes; 0=no Eligible if DIABFL=1

39 Using physician claims, dates where: provider type is optometrist or ophthalmologist (PRV_TYP = 08 or 22) AND (one of the following CPT codes for an eye exam: 67101, 67105, , 67112, 67141, 67145, 67208,67210,67218,67227,67228,9200 2,92004,92012,92014,92018,92019,92 225,92226,92230, 92235,92240,92250,92260,92287, 99204, 99205, 99214, 99215, OR one of the following ICD proc codes: 14.1x-14.5x, 14.9x, , Dates of eye exam DIAEYE DATE 95.11, 95.12, 95.16) Pass 13_02B (2 eye exams during 2 year study period at least Yes if at least 2 eye exams 180 days apart) S13_02B 1=yes; 0=no (DIAEYE) 180 days apart INDICATOR 13_02C: Patients with the diagnosis of Type 1 or Type 2 diabetes should have all of the following: c. Total serum cholesterol and HDL cholesterol tests documented.

40 Eligible for 13_02C (diagnosis of Type 1 or Type 2 diabetes) E13_02C 1=yes; 0=no Eligible if DIABFL=1 Any serum cholesterol Yes if any CPTCODE or PROC* = test performed SERCHODT 1=yes; 0=no 80061, Yes if any CPTCODE or PROC* = HDL cholesterol test HDLCHODT 1=yes; 0=no 80061, 83716, Pass 13_02C (Total serum cholesterol and HDL cholesterol tests documented) S13_02C 1=yes; 0=no Yes if at least 1 total (SERCHODT=1) and HDL cholesterol test (HDLCHODT=1) INDICATOR 13_02D: Patients with the diagnosis of Type 1 or Type 2 diabetes should have all of the following: d. Measurement of urine protein (annual) documented. Eligible for 13_02D (diagnosis of Type 1 or Type 2 diabetes) E13_02D 1=yes;0=no Eligible if DIABFL=1 Dates of urine protein test URNPROT DATE Pass 13_02D (annual measurement of urine protein) S13_02D 1=yes;0=no FROMDATE where CPTCODE or PROC* = , 82042, 82043, Pass if 2 or more urine protein tests at least 180 days apart

41 INDICATOR 13_08: Diabetics with proteinuria should be offered an ACE inhibitor within 3 months of the notation of proteinuria unless contraindicated. Diagnosis of proteinuria PROTEIN DATE Earliest FROMDATE where any DIAG*=791.0 Eligible for 13_08 (diabetic with proteinuria) E13_08 1=yes;0=no Eligible if any proteinuria diagnosis (PROTEIN<>NA) AND DIABFL =1 Prescription for ACE inhibitor ordered within 3 months on or after diagnosis of proteinuria ACERX 1=yes;0=no Pass 13_08 (ACE inhibitor offered within 3 months of proteinuria) S13_08 1=yes;0=no Pass if ACERX=1 Any FILLDATE within 3 months on or after PROTEIN with NDCCODE= code from ACE Inhibitors file & listed after the diabetes claims specifications List of NDCs for Ace Inhibitors was derived from the Multum d_norm table, taking all oral medications where active ingredient = benazepril, captopril, enalapril, fosinopril, irbesartan, lisinopril, losartan, moexipril, quinapril, ramipril, telmisartan, trandolapril, valsartan INDICATOR 13_09: All patients with diabetes should have a follow-up visit at least every 6 months.

42 Eligible for 13_09 (diabetic) E13_09 1=yes; 0=no Eligible if DIABFL=1 Follow-up visit for diabetes DIABETFU 1=yes; 0=no At least 2 outpatient visits per year (1998 and 1999) >= 90+ days apart: FROMDATE where CPTCODE = , Pass 13_09 (follow-up visit for diabetes every 6 months) S13_09 1=yes; 0=no Pass if DIABETFU=1

43 HEART FAILURE Item Definition Variable Name Format Claims Data Algorithm NOTES Earliest FROMDATE with a diagnosis for heart failure where encounter was outpatient, er or inpatient. First heart failure contact FSTCHFDX DATE (1) any DIAG* = 428.xx, , 402.x1, 404.x1, 404.x3, 425.4x, 425.5x AND (2)REVCODE: 49x, 50x, 51x, 52x, 53x, 55x, 56x, 57x, 58x, 59x, 65x, 66x, 76x, 82x, 83x, 84x, 85x, 88x, 92x, 94x, 96x, 972, 973, 974, 975, 976, 977, 978, 979, 982, 983, 984, 985, 986, 988, 989, 10x, 11x, 12x, 13x, 14x, 15x, 16x, 20x, 21x, 22x, 45x, 72x, 80x, 981, 987 CPT: , , , , , , , , , , , , , 99499, , , , , , , , , , , , , Heart failure diagnosis codes (DIAG*): 428.xx - heart failure rheumatic heart failure 402.x1 - hypertensive heart renal disease w/ CHF 404.x1 - hypertensive heart and renal disease w/ CHF 404.x3 - hypertensive heart and renal disease w/ CHF and renal failure 425.4x - other primary cardiomyopathies 425.5x - alcoholic cardiomopathy

44 Item Definition New diagnosis of heart failure (used for multiple indicators) NEWCHFDX DATE Variable Name Format Claims Data Algorithm NOTES New CHF diagnosis is the fist CHF contact in the study, if the first contact is in the 2nd year of the study (if patient has contact in 1st year for heart failure, consdiered to be a prevalent,not incident, case of heart failure) NEWCHFDX=FSTCHFDX if FSTCHFDX>ELIGBEG+12 months, else NEWCHFDX=NA All hosptializations with a primary diagnosis of heart failure: There are no specific ICD-9 codes to identify new diagnoses, will therefore proxy "new" diagnosis by identifying patients with a heart failure code in the 1999, but no heart failure code in Hospital admission for heart failure (used for multiple indicators) HFHOSP* DATE(s) Array All FROMDATE where: (a) DIAG1 = 428.xx, , 402.x1, 404.x1, 404.x1, 404.x3, 425.4x, 425.5x AND (b) SITE_CDE=4 INDICATOR 17_01: Patients newly diagnosed with heart failure who are beginning medical treatment should receive an evaluation of their ejection fraction within 1 month of the start of treatment.

45 Item Definition Prescription for heart failure medications (diuretics, ace inhibitors, hydralazine, nitrates, digoxin) CHFRX DATE Variable Name Format Claims Data Algorithm NOTES Earliest FILLDATE after the diagnosis of heart failure (NEWCHFDX) where the NDCCODE=entry on CHFRX list found at the end of the heart failure specifications The medication was derived using the Multum d_norm table selecting oral medications with the following active ingredients: DIURETICS: amiloride, bendroflumethiazide, benzthiazide, bumetanide, cholorothiazide, chlorthalidone, dichlorphenamide, ethacrynic acid, furosemide, hydrochlorothiazide, hydroflumethiazide, methyclothiazide, metolazone, polythiazide, spironolactone, torsemide, triamterene, trichlormethiazide

46 Item Definition Eligible for 17_01 (new diagnosis of heart failure and started on medication) E17_01 1=yes;0=no Variable Name Format Claims Data Algorithm NOTES CHFRX meds continued. Hydralazine, Digitoxin, Digoxin NITRATES (all routes): amyl nitrate, isosorbide, nitroglycerin ACE INHIBITORS: benazepril, captopril, enalapril, fosinopril, irbesartan, lisinopril, losartan, moexipril, quinapril, ramipril, telmisartan, trandolapril, valsartan Eligible if new diagnosis of heart failure in 1999 (NEWCHFDX<>NA) and treatment initiated within 6 months after diagnosis but at least 1 month prior to the end of the study[ (CHFRX <= (NEWCHFDX + 6 months)) and (CHFRX <= 12/1/1999)]

47 Item Definition Variable Name Format Claims Data Algorithm NOTES Any CPTCODE or PROC* for measurement of echocardiogram between 3 months prior to and 1 month after the initiation of treatment (CHFRX). Measurement of ejection fraction by echocardiogram, radionuclide test or coronary angiogram EFMEAS 1=yes;0=no CPT codes are: 78414, , , , , ICD-9 procedure codes: 8872, Pass 17_01 (Measurement of ejection fraction within one month prior to initiation of medication) S17_01 1=yes;0=no Pass if EFMEAS=1 INDICATOR 17_04A: Patients with a new diagnosis of heart failure should be offered all of the following studies within 1 month of the diagnosis (unless performed within the prior 3 months): Chest x-ray; Eligible for 17 04A (new diagnosis of heart failure) E17_04A 1=yes; 0=no Eligible if new diagnosis of heart failure is 1 month prior to the end of the study period (NEWCHFDX<= 12/1/1999)

48 Item Definition Variable Name Format Claims Data Algorithm NOTES Any CPTCODE or PROC* for chest x- ray between 3 months prior to and 1 month after diagnosis of heart failure (NEWCHFDX). CPT codes are: ICD-9 procedure codes are: Chest x-ray performed CHSTPERF 1=yes; 0=no 8744, 8749 Pass 17_04A (patient offered chest x-ray within 1 month prior to or 3 months after diagnosis of heart failure) S17_04A 1=yes; 0=no Pass if CHSTPERF=1 INDICATOR 17_04B: Patients with a new diagnosis of heart failure should be offered all of the following studies within 1 month of the diagnosis (unless performed within the prior 3 months): EKG; Eligible for 17 04B (new diagnosis of heart failure) E17_04B 1=yes; 0=no Eligible if new diagnosis of heart failure is 1 month prior to the end of the study period (NEWCHFDX<= 12/1/1999)

49 Item Definition Variable Name Format Claims Data Algorithm NOTES Any CPTCODE or PROC* for EKG between 3 months prior to and 1 month after the diagnosis of heart failure (NEWCHFDX). CPT codes are: , ICD-9 procedure codes are: EKG performed EKGPERF 1=yes; 0=no Pass 17_04B (patient offered EKG within 1 month prior to or 3 months after diagnosis of heart failure) S17_04B 1=yes; 0=no Pass if EKGPERF=1 INDICATOR 17_04C: Patients with a new diagnosis of heart failure should be offered all of the following studies within 1 month of the diagnosis (unless performed within the prior 3 months): Complete blood count; Eligible for 17 04C (new diagnosis of heart failure) E17_04C 1=yes; 0=no Eligible if new diagnosis of heart failure is 1 month prior to the end of the study period (NEWCHFDX<= 12/1/1999)

50 Item Definition Variable Name Format Claims Data Algorithm NOTES Any CPTCODE or PROC* for complete blood count between 3 months prior to and 1 month after diagnosis of heart failure (NEWCHFDX). Complete blood count performed CBCPERF 1=yes; 0=no CPT codes are: Pass 17_04C (patient offered CBC within 1 month prior to or 3 months after diagnosis of heart failure) S17_04C 1=yes; 0=no Pass if CBCPERF=1 INDICATOR 17_04D: Patients with a new diagnosis of heart failure should be offered all of the following studies within 1 month of the diagnosis (unless performed within the prior 3 months): Serum sodium, potassium, and bicarbonate; Eligible for 17 04D (new diagnosis of heart failure) E17_04D 1=yes; 0=no Eligible if new diagnosis of heart failure is 1 month prior to the end of the study period (NEWCHFDX<= 12/1/1999)

51 Item Definition Variable Name Format Claims Data Algorithm NOTES Any CPTCODE or PROC* for electrolyte panel or individual chemistries for sodium, potassium, and bicarbonate between 3 months prior to and 1 month after diagnosis of heart failure (NEWCHFDX) Serum sodium, potassium, and bicarbonate performed CPT codes are: or or or or or (84295 & & 82374) or G0096 or G0097 or G0098 ELCTPERF 1=yes; 0=no Pass 17_04D (patient offered measurement of serum sodium, potassium, and bicarbonate within 1 month prior to or 3 months after diagnosis of heart failure) S17_04D 1=yes; 0=no Pass if ELCTPERF=1 INDICATOR 17_04E: Patients with a new diagnosis of heart failure should be offered all of the following studies within 1 month of the diagnosis (unless performed within the prior 3 months): Serum creatinine. Eligible for 17 04E (new diagnosis of heart failure) E17_04E 1=yes; 0=no Eligible if new diagnosis of heart failure is 1 month prior to the end of the study period (NEWCHFDX<= 12/1/1999)

52 Item Definition Variable Name Format Claims Data Algorithm NOTES Any CPTCODE or PROC* for serum creatinine between 3 months prior to and 1 month after diagnosis of heart failure (NEWCHFDX). CPT codes are: 80048, 80050, 80083, 80069, Serum creatinine tested CRETPERF 1=yes; 0=no G0096, G0098 Pass 17_04E (patient offered measurement of serum creatinine within 1 month prior to or 3 months after diagnosis of heart failure) S17_04E 1=yes; 0=no Pass if CRETPERF=1 INDICATOR 17_07A: Patients who are hospitalized for heart failure should have the following performed within one day of hospitalization: Serum electrolytes; and Eligible for 17_07A (admission for symptoms of heart failure) 1=yes;0=no E17_07A* array Eligible if HFHOSP*<>NA Any CPTCODE or PROC* for serum electrolytes during hospitalization for heart failure (HFHOSP*) Serum electrolytes measured ELECIP* 1=yes;0=no array CPT codes are: 80048, 80050, 80051, 80053, 80069, G0096, G0097, G0098

53 Item Definition Pass 17_07A (serum electrolytes measured within one day of hospitalization) Variable Name Format Claims Data Algorithm NOTES S17_07A* 1=yes;0=no array Pass if ELECTRO=1 INDICATOR 17_07B: Patients who are hospitalized for heart failure should have the following performed within one day of hospitalization: Serum creatinine. Eligible for 17_07B (admission for symptoms of heart failure) 1=yes;0=no E17_07B* array Eligible if HFHOSP*<>NA Any CPTCODE or PROC* for serum creatinine during hospitalization for heart failure (HFHOSP). Serum creatinine tested CRETIP* Pass 17_07B (serum electrolytes measured within one day of hospitalization) S17_07B* 1=yes;0=no array CPT codes are: 80048, 80050, 80083, 80069, G0096, G0098 1=yes;0=no array Pass if CRETIP*=1 INDICATOR 17_09A: Patients with the diagnosis of heart failure who are on an ACE inhibitor should have the following checked every year: Serum potassium;