eCQM Title | # Primary Caries Prevention Intervention as Offered by Dentists
eCQM Identifier (Measure Authoring Tool) | 74 | eCQM Version Number | 13.0.000
NQF Number | Not Applicable | GUID | 0b81b6ba-3b30-41bf-a2f3-95bdc9f558f2
Measurement Period | January 1, 20XX through December 31, 20XX
Measure Steward | Centers for Medicare & Medicaid Services (CMS)
Measure Developer | National Committee for Quality Assurance
Endorsed By | None
Description |
    Percentage of children, 1 - 20 years of age, who received two fluoride varnish applications during the measurement period as determined by a dentist
Copyright |
    This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. 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.

    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) codes, descriptions and other data are copyright 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

    LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation.

    ICD-10 copyright 2022 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 |
    Population 1: Patients age 1-5 years at the start of the Measurement Period
    Population 2: Patients age 6-12 years at the start of the Measurement Period
    Population 3: Patients age 13-20 years at the start of the Measurement Period
Risk Adjustment |
    None
Rate Aggregation |
    None
Rationale |
    The literature reflects that fluoride varnish, when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries (Weyant et al., 2013). Evidence in the literature also specifically supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children (Chou et al., 2014).
Clinical Recommendation Statement |
    The 2013 American Dental Association (ADA) clinical recommendations for use of professionally applied or prescription-strength, home-use topical fluorides for caries prevention in patients at elevated risk of developing caries:

    - Younger Than 6 Years - 2.26 percent fluoride varnish at least every three to six months

    - 6-18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF*) gel for four minutes at least every three to six months

    - Older Than 18 Years - 2.26 percent fluoride varnish at least every three to six months OR 1.23 percent fluoride (APF) gel for four minutes at least every three to six months (Weyant et al., 2013)

    The United States Preventive Services Taskforce (USPSTF) recommends the use of professionally applied fluoride varnish for the prevention of dental caries in high risk children under 5 years of age (Chou et al., 2014).
Improvement Notation |
    A higher score indicates better quality
Reference |
    Reference Type: CITATION
    Reference Text: 'Chou R, Cantor A, Zakher B, Mitchell JP, Pappas M. Prevention of Dental Caries in Children Younger Than 5 Years Old: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 104. AHRQ Publication No. 12-05170- EF-1. Rockville, Md.: Agency for Healthcare Research and Quality; 2014'
Reference |
    Reference Type: CITATION
    Reference Text: 'Weyant, R. J., Tracy, S. L., Anselmo, T. (Tracy), Beltrán-Aguilar, E. D., Donly, K. J., Frese, W. A., Hujoel, P. P., Iafolla, T., Kohn, W., Kumar, J., Levy, S. M., Tinanoff, N., Wright, J. T., Zero, D., Aravamudhan, K., Frantsve-Hawley, J., & Meyer, D. M. (2013). Topical Fluoride for Caries Prevention. The Journal of the American Dental Association, 144(11), 1279–1291. https://doi.org/10.14219/jada.archive.2013.0057'
Definition |
    None
Guidance |
    This eCQM is a patient-based measure.

    Telehealth encounters are not eligible for this measure because the measure does not contain telehealth-eligible codes and requires a clinical action that cannot be conducted via telehealth.

    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 |
    Children, 1 - 20 years of age at the start of the measurement period, with a clinical oral evaluation by a dentist during the measurement period
Denominator |
    Equals Initial Population
Denominator Exclusions |
    Exclude patients who are in hospice care for any part of the measurement period
Numerator |
    Children who receive two fluoride varnish applications on different days 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

- - Initial Population

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[1, 20]
              and exists ( "Qualifying Encounters" )

- - Denominator

    - -     "Initial Population"

- - Denominator Exclusions

    - -     Hospice."Has Hospice Services"

- - Numerator

    - -     Count(["Procedure, Performed": "Fluoride Varnish Application for Children"] FluorideApplication
                where Global."NormalizeInterval"(FluorideApplication.relevantDatetime, FluorideApplication.relevantPeriod)ends during day of "Measurement Period"
                return distinct date from
                end of Global."NormalizeInterval"(FluorideApplication.relevantDatetime, FluorideApplication.relevantPeriod)
            )>= 2

- - Numerator Exclusions

    - -     None

- - Denominator Exceptions

    - -     None

- - Stratification 1

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[1, 5]

- - Stratification 2

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[6, 12]

- - Stratification 3

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[13, 20]

### Definitions

- - Denominator

    - -     "Initial Population"

  - Denominator Exclusions

    - -     Hospice."Has Hospice Services"

  - 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 day of "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 day of "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 day of "Measurement Period"
              )
            or exists ( ["Diagnosis": "Hospice Diagnosis"] HospiceCareDiagnosis
                  where HospiceCareDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
              )

  - Initial Population

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[1, 20]
              and exists ( "Qualifying Encounters" )

  - Numerator

    - -     Count(["Procedure, Performed": "Fluoride Varnish Application for Children"] FluorideApplication
                where Global."NormalizeInterval"(FluorideApplication.relevantDatetime, FluorideApplication.relevantPeriod)ends during day of "Measurement Period"
                return distinct date from
                end of Global."NormalizeInterval"(FluorideApplication.relevantDatetime, FluorideApplication.relevantPeriod)
            )>= 2

  - Qualifying Encounters

    - -     ["Encounter, Performed": "Clinical Oral Evaluation"] ValidEncounter
              where ValidEncounter.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 start of "Measurement Period")in Interval[1, 5]

  - Stratification 2

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[6, 12]

  - Stratification 3

    - -     AgeInYearsAt(date from start of "Measurement Period")in Interval[13, 20]

### 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 "Clinical Oral Evaluation" (2.16.840.1.113883.3.464.1003.125.12.1003)
- valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
- valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
- valueset "Fluoride Varnish Application for Children" (2.16.840.1.113883.3.464.1003.125.12.1002)
- valueset "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
- valueset "Hospice Diagnosis" (2.16.840.1.113883.3.464.1003.1165)
- valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
- valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
- valueset "Payer" (2.16.840.1.114222.4.11.3591)
- valueset "Race" (2.16.840.1.114222.4.11.836)

### Data Criteria (QDM Data Elements)

- "Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
- "Diagnosis: Hospice Diagnosis" using "Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165)"
- "Encounter, Performed: Clinical Oral Evaluation" using "Clinical Oral Evaluation (2.16.840.1.113883.3.464.1003.125.12.1003)"
- "Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
- "Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
- "Intervention, Order: Hospice Care Ambulatory" using "Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584)"
- "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)"
- "Procedure, Performed: Fluoride Varnish Application for Children" using "Fluoride Varnish Application for Children (2.16.840.1.113883.3.464.1003.125.12.1002)"

### 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 |
    Not Applicable