eCQM Title | Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
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eCQM Identifier (Measure Authoring Tool) | 122 | eCQM Version Number | 9.3.000 |
NQF Number | Not Applicable | GUID | f2986519-5a4e-4149-a8f2-af0a1dc7f6bc |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | National Committee for Quality Assurance | ||
Measure Developer | National Committee for Quality Assurance | ||
Endorsed By | None | ||
Description |
Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period |
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Copyright |
This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2019 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 copyright 2019 World Health Organization. All Rights Reserved. |
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Disclaimer |
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. |
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Measure Scoring | Proportion | ||
Measure Type | Intermediate Clinical Outcome | ||
Stratification |
None |
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Risk Adjustment |
None |
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Rate Aggregation |
None |
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Rationale |
As the seventh leading cause of death in the U.S., diabetes kills approximately 79,500 people a year and affects more than 30 million Americans (9.4 percent of the U.S. population) (Centers for Disease Control and Prevention [CDC], 2017a, 2017b). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2019). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death (CDC, 2016). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association, 2018). Controlling A1c blood levels help reduce the risk of microvascular complications (eye, kidney and nerve diseases) (CDC, 2014). |
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Clinical Recommendation Statement |
American Diabetes Association (2019): - A reasonable A1C goal for many nonpregnant adults is <7%. (Level of evidence: A) - Providers might reasonably suggest more stringent A1C goals (such as <6.5% [48 mmol/mol]) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment (i.e. polypharmacy). Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease (CVD). (Level of evidence: C) - Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin. (Level of evidence: B) |
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Improvement Notation |
Lower score indicates better quality |
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Reference |
American Diabetes Association. (2018). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007 |
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Reference |
American Diabetes Association. (2019). 6. Glycemic targets: Standards of medical care in diabetes—2019. Diabetes Care, 42(Suppl. 1), S61-S70. https://doi.org/10.2337/dc19-S006 |
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Reference |
Centers for Disease Control and Prevention. (2014). National diabetes statistics report, 2014. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from http://www.thefdha.org/pdf/diabetes.pdf |
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Reference |
Centers for Disease Control and Prevention. (2016). At a glance 2016: Diabetes—Working to reverse the U.S. epidemic. Atlanta, GA: Author. Retrieved from https://upcap.org/admin/wp-content/uploads/2016/06/Diabetes-at-a-Glance.pdf |
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Reference |
Centers for Disease Control and Prevention. (2017a). Health, United States, 2016: With chartbook on long-term trends in health. Retrieved from https://www.cdc.gov/nchs/data/hus/hus16.pdf |
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Reference |
Centers for Disease Control and Prevention. (2017b). National diabetes statistics report, 2017. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf |
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Reference |
Centers for Disease Control and Prevention. (2019). About diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html |
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Definition |
None |
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Guidance |
Patient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance. Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
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Transmission Format |
TBD |
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Initial Population |
Patients 18-75 years of age with diabetes with a visit during the measurement period |
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Denominator |
Equals Initial Population |
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Denominator Exclusions |
Exclude patients whose hospice care overlaps the measurement period. Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period. Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured. |
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Numerator |
Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% |
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Numerator Exclusions |
Not Applicable |
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Denominator Exceptions |
None |
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Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 75 ) ) and exists ( AdultOutpatientEncounters."Qualifying Encounters" ) and exists ( ["Diagnosis": "Diabetes"] Diabetes where Diabetes.prevalencePeriod overlaps "Measurement Period" )
"Initial Population"
Hospice."Has Hospice" or FrailtyLTI."Advanced Illness and Frailty Exclusion Not Including Over Age 80" or ( exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where ( Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 ) and FrailtyLTI."Long Term Care Periods Longer Than 90 Consecutive Days" )
"Has Most Recent HbA1c Without Result" or "Has Most Recent Elevated HbA1c" or "Has No Record Of HbA1c"
None
None
None
( ["Encounter, Performed": "Office Visit"] union ["Encounter, Performed": "Annual Wellness Visit"] union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"] union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"] union ["Encounter, Performed": "Home Healthcare Services"] ) ValidEncounter where ValidEncounter.relevantPeriod during "Measurement Period"
//If the measure does NOT include populations age 80 and older, then use this logic: exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 and "Has Criteria Indicating Frailty" and ( Count("Outpatient Encounters with Advanced Illness")>= 2 or exists ( "Inpatient Encounter with Advanced Illness" ) or exists "Dementia Medications In Year Before or During Measurement Period" ) )
["Medication, Active": "Dementia Medications"] DementiaMed where DementiaMed.relevantPeriod overlaps Interval[( start of "Measurement Period" - 1 year ), end of "Measurement Period"]
exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder where FrailtyDeviceOrder.authorDatetime during "Measurement Period" ) or exists ( ["Device, Applied": "Frailty Device"] FrailtyDeviceApplied where FrailtyDeviceApplied.relevantPeriod overlaps "Measurement Period" ) or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis where FrailtyDiagnosis.prevalencePeriod overlaps "Measurement Period" ) or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter where FrailtyEncounter.relevantPeriod overlaps "Measurement Period" ) or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom where FrailtySymptom.prevalencePeriod overlaps "Measurement Period" )
["Encounter, Performed": "Acute Inpatient"] InpatientEncounter where exists ( InpatientEncounter.diagnoses Diagnosis where Diagnosis.code in "Advanced Illness" ) and InpatientEncounter.relevantPeriod starts 2 years or less on or before end of "Measurement Period"
( ["Encounter, Performed": "Care Services in Long-Term Residential Facility"] union ["Encounter, Performed": "Nursing Facility Visit"] ) LongTermFacilityEncounter where LongTermFacilityEncounter.relevantPeriod overlaps "Measurement Period" return LongTermFacilityEncounter.relevantPeriod intersect "Measurement Period"
exists ( "Long Term Care Periods During Measurement Period" LongTermCareDuringMP where duration in days of LongTermCareDuringMP > 90 )
( ["Encounter, Performed": "Outpatient"] union ["Encounter, Performed": "Observation"] union ["Encounter, Performed": "ED"] union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter where exists ( OutpatientEncounter.diagnoses Diagnosis where Diagnosis.code in "Advanced Illness" ) and OutpatientEncounter.relevantPeriod starts 2 years or less on or before end of "Measurement Period"
"Initial Population"
Hospice."Has Hospice" or FrailtyLTI."Advanced Illness and Frailty Exclusion Not Including Over Age 80" or ( exists ["Patient Characteristic Birthdate": "Birth date"] BirthDate where ( Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65 ) and FrailtyLTI."Long Term Care Periods Longer Than 90 Consecutive Days" )
"Most Recent HbA1c".result > 9 '%'
"Most Recent HbA1c" is not null and "Most Recent HbA1c".result is null
not exists ( ["Laboratory Test, Performed": "HbA1c Laboratory Test"] NoHbA1c where NoHbA1c.relevantDatetime during "Measurement Period" )
exists ( ["Encounter, Performed": "Encounter Inpatient"] DischargeHospice where ( DischargeHospice.dischargeDisposition ~ "Discharge to home for hospice care (procedure)" or DischargeHospice.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)" ) and DischargeHospice.relevantPeriod ends during "Measurement Period" ) or exists ( ["Intervention, Order": "Hospice care ambulatory"] HospiceOrder where HospiceOrder.authorDatetime during "Measurement Period" ) or exists ( ["Intervention, Performed": "Hospice care ambulatory"] HospicePerformed where HospicePerformed.relevantPeriod overlaps "Measurement Period" )
exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate where Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) in Interval[18, 75 ) ) and exists ( AdultOutpatientEncounters."Qualifying Encounters" ) and exists ( ["Diagnosis": "Diabetes"] Diabetes where Diabetes.prevalencePeriod overlaps "Measurement Period" )
Last(["Laboratory Test, Performed": "HbA1c Laboratory Test"] RecentHbA1c where RecentHbA1c.relevantDatetime during "Measurement Period" sort by relevantDatetime )
"Has Most Recent HbA1c Without Result" or "Has Most Recent Elevated HbA1c" or "Has No Record Of HbA1c"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
years between ToDate(BirthDateTime)and ToDate(AsOf)
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
None |
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