eCQM Title | # Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
eCQM Identifier (Measure Authoring Tool) | 155 | eCQM Version Number | 11.0.000
NQF Number | Not Applicable | GUID | 0b63f730-25d6-4248-b11f-8c09c66a04eb
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 3-17 years of age who had an outpatient visit with a primary care physician (PCP) or obstetrician/gynecologist (OB/GYN) and who had evidence of the following during the measurement period.

     - Percentage of patients with height, weight, and body mass index (BMI) percentile documentation
     - Percentage of patients with counseling for nutrition
     - Percentage of patients with counseling for physical activity
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) 2012-2021 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 2004-2021 American Medical Association. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.
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].
Measure Scoring | Proportion
Measure Type | Process
Stratification |
    Report a total score, and each of the following strata:
    Stratum 1 - Patients age 3-11 years at the end of the measurement period
    Stratum 2 - Patients age 12-17 years at the end of the measurement period
Risk Adjustment |
    None
Rate Aggregation |
    None
Rationale |
    Over the last four decades, childhood obesity has more than tripled in children and adolescents 2 to 19 years of age (from a rate of approximately 5 percent to 18.5 percent) (Fryar, Carroll, & Ogden, 2014; Hales et al., 2017). Non-Hispanic black and Hispanic youth are more likely to be obese than their non-Hispanic white and non-Hispanic Asian counterparts. In 2015-2016, approximately 22 percent of non-Hispanic black and 26 percent of Hispanic youth were obese compared to approximately 14 percent of non-Hispanic white and 11 percent of non-Hispanic Asian youth (Hales et al., 2017).

    Childhood obesity has both immediate and long-term effects on health and well-being. Children who are obese have higher rates of physical health conditions, such as risk factors for cardiovascular disease (like high blood pressure and high cholesterol), type 2 diabetes, asthma, sleep apnea, and joint problems. There is also a correlation between childhood obesity and mental health conditions, such as anxiety and depression (Centers for Disease Control and Prevention, 2016). In addition, children who are obese are more likely to be obese as adults and are therefore at risk for adult health problems, such as heart disease, type 2 diabetes, and several types of cancer (Centers for Disease Control and Prevention, 2016).

    The direct medical costs associated with childhood obesity total about $19,000 per child, contributing to the $14 billion spent on care related to childhood obesity in the United States (Finkelstein, Graham, & Malhotra, 2014).

    Because obesity can become a lifelong health issue, it is important to screen for obesity in children and adolescents, and to provide interventions that promote weight loss (U.S. Preventive Services Task Force, 2017).
Clinical Recommendation Statement |
    U.S. Preventive Services Task Force (2017) - The Task Force recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. (B recommendation)

    American Academy of Pediatrics – Bright Futures (Hagan, Shaw, & Duncan, 2017)

    - Plot and assess BMI percentiles routinely for early recognition of overweight and obesity.
    - Assess barriers to healthy eating and physical activity.
    - Provide anticipatory guidance for nutrition and physical activity.
Improvement Notation |
    Higher score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'Centers for Disease Control and Prevention. (2016). Childhood Obesity Causes & Consequences. Retrieved from https://www.cdc.gov/obesity/childhood/causes.html'
Reference |
    Reference Type: CITATION
    Reference Text: 'Finkelstein, E. A., Graham, W. C. K., & Malhotra, R. (2014). Lifetime Direct Medical Costs of Childhood Obesity. Pediatrics, 133(5), 854-862.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Fryar, C. D., Carroll, M. D., & Ogden, C. L. (2014). Prevalence of Overweight and Obesity Among Children and Adolescents: United States, 1963-1965 through 2011-2012. Health E-Stats. Retrieved from https://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.htm'
Reference |
    Reference Type: CITATION
    Reference Text: 'Hagan, J. F., Shaw, J. S., & Duncan, P. M. (eds.). (2017). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.'
Reference |
    Reference Type: CITATION
    Reference Text: 'Hales, C.M., Carroll, M.D., Fryar C.D., et al. (2017). Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db288.pdf'
Reference |
    Reference Type: CITATION
    Reference Text: 'U.S. Preventive Services Task Force. (2017). Screening and interventions for overweight in children and adolescents: Recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality.  https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/obesity-in-children-and-adolescents-screening1?ds=1&s=obesity'
Definition |
    None
Guidance |
    The visit must be performed by a PCP or OB/GYN.
    Because BMI norms for youth vary with age and sex, this measure evaluates whether BMI percentile, rather than an absolute BMI value, is assessed.

    This eCQM is a patient-based measure.

    This version of the eCQM uses QDM version 5.6.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Transmission Format |
    TBD
Initial Population |
    Patients 3-17 years of age by the end of the measurement period, with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period
Denominator |
    Equals Initial Population
Denominator Exclusions |
    Patients who have a diagnosis of pregnancy during the measurement period.

    Exclude patients who are in hospice care for any part of the measurement period.
Numerator |
    Numerator 1: Patients who had a height, weight and body mass index (BMI) percentile recorded during the measurement period
    Numerator 2: Patients who had counseling for nutrition during the measurement period
    Numerator 3: Patients who had counseling for physical activity during the measurement period
Numerator Exclusions |
    Not Applicable
Denominator Exceptions |
    None
Supplemental Data Elements |
    For every patient evaluated by this measure also identify payer, race, ethnicity and sex

## Table of Contents

- Population Criteria
- Definitions
- Functions
- Terminology
- Data Criteria (QDM Data Elements)
- Supplemental Data Elements
- Risk Adjustment Variables

### Population Criteria

- Population Criteria 1
  - - Initial Population

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[3, 17]
                and exists ( "Qualifying Encounters" )

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"
                or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

  - - Numerator

      - -     exists ( "BMI Percentile in Measurement Period" )
                and exists ( "Height in Measurement Period" )
                and exists ( "Weight in Measurement Period" )

  - - Numerator Exclusions

      - -     None

  - - Denominator Exceptions

      - -     None

  - - Stratification 1

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[3, 11]

  - - Stratification 2

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[12, 17]

- Population Criteria 2
  - - Initial Population

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[3, 17]
                and exists ( "Qualifying Encounters" )

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"
                or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

  - - Numerator

      - -     exists ["Intervention, Performed": "Counseling for Nutrition"] NutritionCounseling
                where Global."NormalizeInterval" ( NutritionCounseling.relevantDatetime, NutritionCounseling.relevantPeriod ) during day of "Measurement Period"

  - - Numerator Exclusions

      - -     None

  - - Denominator Exceptions

      - -     None

  - - Stratification 1

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[3, 11]

  - - Stratification 2

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[12, 17]

- Population Criteria 3
  - - Initial Population

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[3, 17]
                and exists ( "Qualifying Encounters" )

  - - Denominator

      - -     "Initial Population"

  - - Denominator Exclusions

      - -     Hospice."Has Hospice Services"
                or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

  - - Numerator

      - -     exists ["Intervention, Performed": "Counseling for Physical Activity"] ActivityCounseling
                where Global."NormalizeInterval" ( ActivityCounseling.relevantDatetime, ActivityCounseling.relevantPeriod ) during day of "Measurement Period"

  - - Numerator Exclusions

      - -     None

  - - Denominator Exceptions

      - -     None

  - - Stratification 1

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[3, 11]

  - - Stratification 2

      - -     AgeInYearsAt(date from
                end of "Measurement Period"
              )in Interval[12, 17]

### Definitions

- - BMI Percentile in Measurement Period

    - -     ["Physical Exam, Performed": "BMI percentile"] BMIPercentile
              where Global."NormalizeInterval" ( BMIPercentile.relevantDatetime, BMIPercentile.relevantPeriod ) during day of "Measurement Period"
                and BMIPercentile.result is not null

  - Denominator

    - -     "Initial Population"

  - Denominator Exclusions

    - -     Hospice."Has Hospice Services"
              or exists ( "Pregnancy Diagnosis Which Overlaps Measurement Period" )

  - Height in Measurement Period

    - -     ["Physical Exam, Performed": "Height"] Height
              where Global."NormalizeInterval" ( Height.relevantDatetime, Height.relevantPeriod ) during day of "Measurement Period"
                and Height.result is not null

  - Hospice.Has Hospice Services

    - -     exists ( ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
                where ( InpatientEncounter.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
                    or InpatientEncounter.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
                )
                  and InpatientEncounter.relevantPeriod ends during day of "Measurement Period"
            )
              or exists ( ["Encounter, Performed": "Hospice Encounter"] HospiceEncounter
                  where HospiceEncounter.relevantPeriod overlaps "Measurement Period"
              )
              or exists ( ["Assessment, Performed": "Hospice care [Minimum Data Set]"] HospiceAssessment
                  where HospiceAssessment.result ~ "Yes (qualifier value)"
                    and Global."NormalizeInterval" ( HospiceAssessment.relevantDatetime, HospiceAssessment.relevantPeriod ) overlaps "Measurement Period"
              )
              or exists ( ["Intervention, Order": "Hospice Care Ambulatory"] HospiceOrder
                  where HospiceOrder.authorDatetime during day of "Measurement Period"
              )
              or exists ( ["Intervention, Performed": "Hospice Care Ambulatory"] HospicePerformed
                  where Global."NormalizeInterval" ( HospicePerformed.relevantDatetime, HospicePerformed.relevantPeriod ) overlaps "Measurement Period"
              )

  - Initial Population

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[3, 17]
              and exists ( "Qualifying Encounters" )

  - Numerator 1

    - -     exists ( "BMI Percentile in Measurement Period" )
              and exists ( "Height in Measurement Period" )
              and exists ( "Weight in Measurement Period" )

  - Numerator 2

    - -     exists ["Intervention, Performed": "Counseling for Nutrition"] NutritionCounseling
              where Global."NormalizeInterval" ( NutritionCounseling.relevantDatetime, NutritionCounseling.relevantPeriod ) during day of "Measurement Period"

  - Numerator 3

    - -     exists ["Intervention, Performed": "Counseling for Physical Activity"] ActivityCounseling
              where Global."NormalizeInterval" ( ActivityCounseling.relevantDatetime, ActivityCounseling.relevantPeriod ) during day of "Measurement Period"

  - Pregnancy Diagnosis Which Overlaps Measurement Period

    - -     ["Diagnosis": "Pregnancy"] Pregnancy
              where Pregnancy.prevalencePeriod overlaps "Measurement Period"

  - Qualifying Encounters

    - -     ( ["Encounter, Performed": "Office Visit"]
              union ["Encounter, Performed": "Preventive Care Services Individual Counseling"]
              union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
              union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
              union ["Encounter, Performed": "Preventive Care Services Group Counseling"]
              union ["Encounter, Performed": "Home Healthcare Services"]
              union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounters
              where ValidEncounters.relevantPeriod during day of "Measurement Period"

  - SDE Ethnicity

    - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

  - SDE Payer

    - -     ["Patient Characteristic Payer": "Payer"]

  - SDE Race

    - -     ["Patient Characteristic Race": "Race"]

  - SDE Sex

    - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

  - Stratification 1

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[3, 11]

  - Stratification 2

    - -     AgeInYearsAt(date from
              end of "Measurement Period"
            )in Interval[12, 17]

  - Weight in Measurement Period

    - -     ["Physical Exam, Performed": "Weight"] Weight
              where Global."NormalizeInterval" ( Weight.relevantDatetime, Weight.relevantPeriod ) during day of "Measurement Period"
                and Weight.result is not null

### Functions

- - Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

    - -     if pointInTime is not null then Interval[pointInTime, pointInTime]
              else if period is not null then period
              else null as Interval<DateTime>

### Terminology

- code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
- code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
- code "Hospice care [Minimum Data Set]" ("LOINC Code (45755-6)")
- code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
- valueset "BMI percentile" (2.16.840.1.113883.3.464.1003.121.12.1012)
- valueset "Counseling for Nutrition" (2.16.840.1.113883.3.464.1003.195.12.1003)
- valueset "Counseling for Physical Activity" (2.16.840.1.113883.3.464.1003.118.12.1035)
- valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "Height" (2.16.840.1.113883.3.464.1003.121.12.1014)
- valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
- valueset "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
- valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
- valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
- valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
- valueset "Payer" (2.16.840.1.114222.4.11.3591)
- valueset "Pregnancy" (2.16.840.1.113883.3.526.3.378)
- valueset "Preventive Care Services Group Counseling" (2.16.840.1.113883.3.464.1003.101.12.1027)
- valueset "Preventive Care Services Individual Counseling" (2.16.840.1.113883.3.464.1003.101.12.1026)
- valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
- valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
- valueset "Race" (2.16.840.1.114222.4.11.836)
- valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
- valueset "Weight" (2.16.840.1.113883.3.464.1003.121.12.1015)

### Data Criteria (QDM Data Elements)

- "Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
- "Diagnosis: Pregnancy" using "Pregnancy (2.16.840.1.113883.3.526.3.378)"
- "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
- "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
- "Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
- "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
- "Encounter, Performed: Preventive Care Services Group Counseling" using "Preventive Care Services Group Counseling (2.16.840.1.113883.3.464.1003.101.12.1027)"
- "Encounter, Performed: Preventive Care Services Individual Counseling" using "Preventive Care Services Individual Counseling (2.16.840.1.113883.3.464.1003.101.12.1026)"
- "Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
- "Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
- "Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
- "Intervention, Order: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
- "Intervention, Performed: Counseling for Nutrition" using "Counseling for Nutrition (2.16.840.1.113883.3.464.1003.195.12.1003)"
- "Intervention, Performed: Counseling for Physical Activity" using "Counseling for Physical Activity (2.16.840.1.113883.3.464.1003.118.12.1035)"
- "Intervention, Performed: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
- "Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
- "Patient Characteristic Payer: Payer" using "Payer (2.16.840.1.114222.4.11.3591)"
- "Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
- "Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
- "Physical Exam, Performed: BMI percentile" using "BMI percentile (2.16.840.1.113883.3.464.1003.121.12.1012)"
- "Physical Exam, Performed: Height" using "Height (2.16.840.1.113883.3.464.1003.121.12.1014)"
- "Physical Exam, Performed: Weight" using "Weight (2.16.840.1.113883.3.464.1003.121.12.1015)"

### Supplemental Data Elements

- SDE Ethnicity

  - -     ["Patient Characteristic Ethnicity": "Ethnicity"]

- SDE Payer

  - -     ["Patient Characteristic Payer": "Payer"]

- SDE Race

  - -     ["Patient Characteristic Race": "Race"]

- SDE Sex

  - -     ["Patient Characteristic Sex": "ONC Administrative Sex"]

### Risk Adjustment Variables

- None

Measure Set |
    None