Performance Measurement Management of Coronary Artery Disease: Review of the Performance Measures by the Performance Measurement Committee of the American College of Physicians Writing Committee Amir Qaseem, MD, Eileen D. Barrett, MD, J. Thomas Cross, MD, Andrew Dunn, MD, Nick Fitterman, MD, Robert A. Gluckman, MD, Susan Thompson Hingle, MD, Kesavan Kutty, MD, Eve A. Kerr, MD, Ana Maria López, MD, Catherine MacLean, MD, Stephen D. Persell, MD, and Terrence Shaneyfelt, MD, and Sarah West, RN ACP Performance Measurement Committee Members* Eve A. Kerr, MD, MPH (Chair); Catherine MacLean, MD, PhD (Vice Chair); Eileen D. Barrett, MD, MPH; J. Thomas Cross, MD, MPH; Andrew Dunn, MD; Nick Fitterman, MD; Robert A. Gluckman, MD; Susan Thompson Hingle, MD; Kesavan Kutty, MD; Ana Maria López, MD, MPH; Stephen D. Persell, MD, MPH; and Terrence Shaneyfelt, MD, MPH Corresponding author: A. Qaseem 190 N. Independence Mall West Philadelphia, PA 19106 Email aqaseem@acponline.org * Individuals who served on the Performance Measurement Committee from initiation of the project until its approval
ACP supports NQF 0066: Coronary Artery Disease: Angiotensin Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy-Diabetes or Left Ventricular Systolic Dysfunction (LVEF <40%). ACP supports this measure because the current evidence supports the use of ACE-I/ ARB therapy for patients with a LVEF <40%. NQF 0066: Coronary Artery Disease: ACE Inhibitor or ARB Therapy-Diabetes or Left Ventricular Systolic Dysfunction (LVEF <40%) Status: NQF Endorsed, Last Updated Dec 23, 2014 (2015 PQRS Measure #118) Measure American College of Cardiology coronary artery disease seen within a 12 month period who also have diabetes OR a current or prior Left Ventricular Ejection Fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy Patients who were prescribed ACE inhibitor or ARB therapy disease (CAD) seen within a 12 month period who also have diabetes or a current or prior LVEF <40% Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g., allergy, intolerant, pregnancy, renal failure due to ACE inhibitor, diseases of the aortic or mitral valve, other medical reasons) Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g., patient declined, other patient reasons) Documentation of system reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g., lack of drug availability, other reasons attributable to the health care system) Clinician: Group, Clinician: Individual Electronic administrative data/claims, Electronic Clinical Data, Electronic Health/Medical Record, Registry data
ACP supports NQF 0067: Chronic Stable Coronary Artery Disease-Antiplatelet Therapy. ACP supports this measure because the current evidence supports the benefit of antiplatelet therapy in reducing complications in adults with CAD. The measure details reduce the administrative burden of documenting patient/medical reasons for withholding aspirin therapy. Lastly, the measure limits preventable adverse events by excluding patients who have already been prescribed warfarin therapy. NQF 0067: Chronic Stable Coronary Artery Disease-Antiplatelet Therapy Status: NQF Endorsed, Last Updated May 06, 2014 (2015 PQRS Measure #6) Measure American College of Cardiology coronary artery disease seen within a 12 month period who were prescribed aspirin or clopidogrel Patients who were prescribed aspirin or clopidogrel * within a 12 month period *Prescribed may include prescription given to the patient for aspirin or clopidogrel at one or more visits in the measurement period OR patient already taking aspirin or clopidogrel as documented in current medication list disease seen within a 12 month period Documentation of medical reason(s) for not prescribing aspirin or clopidogrel (e.g., allergy, intolerant, receiving other thienopyridine therapy, bleeding coagulation disorders, receiving warfarin therapy, other medical reasons) Documentation of patient reason(s) for not prescribing aspirin or clopidogrel (e.g., patient declined, other patient reasons) Documentation of system reason(s) for not prescribing aspirin or clopidogrel (e.g., lack of drug availability, other reasons attributable to the health care system) Clinicians: Group/Practice, Clinicians: Individual Ambulatory Care: Clinician Office/Clinic, Ambulatory Care: Clinician Office/Clinic, Ambulatory Care: Urgent Care, Assisted Living, Home Health, Nursing Home/Skilled Nursing Facility, Outpatient Administrative claims, Electronic Clinical Data, Electronic Health Record, Registry
ACP does not support NQF 0070: Coronary Artery Disease: Beta-Blocker Therapy-Prior Myocardial Infarction or Left Ventricular Ejection Fraction <40%. ACP does not support this measure because it is unnecessarily burdensome for physicians to look at all LVEF assessments in a complete patient history; a better measure would limit the look-back window. There is no evidence base for an indefinite window. Furthermore, the evidence base for prescribing beta-blocker therapy for patients with remote MIs is decreasing. NQF 0070: Coronary Artery Disease: Beta-Blocker Therapy-Prior MI or LVEF <40% Status: NQF Endorsed, Last Updated Jul 01, 2014 (2015 PQRS Measure #7) Measure AMA-Convened Physician Consortium for Performance Improvement coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy Patients who were prescribed beta-blocker therapy disease seen within a 12 month period who also have prior MI or a current or prior LVEF <40% Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons) Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons) Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system) Clinician: Group/Practice, Clinician: Individual Post-Acute/Long Term Care Facility : Nursing Home/Skilled Nursing Facility; Behavioral Health/Psychiatric : Outpatient; Home Health; Ambulatory Care : Clinician Office/Clinic; Ambulatory Care : Urgent Care Administrative claims, Electronic Clinical Data, Electronic Clinical Data: Electronic Health Record, Electronic Clinical Data: Registry
Financial Financial support for the Performance Measurement Committee comes exclusively from the ACP operating budget. Conflicts of Interest: Any financial and nonfinancial conflicts of interest of the group members were declared, discussed, and resolved. A record of conflicts of interest is kept for each PMC meeting and conference call and can be viewed at: http://www.acponline.org/running_practice/performance_measurement/pmc/conflicts_pmc.h tm APPROVED BY THE ACP BOARD OF REGENTS ON: November 7, 2015 Members of the PMC: Individuals who served on the Performance Measurement Committee from initiation of the project until its approval: Eileen D. Barrett, MD, MPH J. Thomas Cross, Jr., MD, MPH Andrew Dunn, MD Nick Fitterman, MD Robert A. Gluckman, MD Susan Thompson Hingle, MD Kesavan Kutty, MD Eve Askanas Kerr, MD, MPH Ana María López, MD, MPH Catherine MacLean, MD, PhD Stephen D. Persell, MD, MPH Terrence Shaneyfelt, MD, MPH Requests and inquiries: Amir Qaseem, MD, PhD, MHA, FACP, American College of Physicians, 190. N Independence Mall West, Philadelphia, PA 19106: email, aqaseem@acponline.org