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Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Compare Versions of: "Statin Therapy for the Prevention and Treatment of Cardiovascular Disease"

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Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period 2025 Performance Period
Title Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Statin Therapy for the Prevention and Treatment of Cardiovascular Disease Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
CMS eCQM ID CMS347v5 CMS347v6 CMS347v7 CMS347v8
CBE ID Not Applicable Not Applicable Not Applicable Not Applicable
MIPS Quality ID 438 438 438 438
Measure Steward Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS)
Description

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*All patients who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR

*Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

*Patients aged 40-75 years with a diagnosis of diabetes

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

*All patients with an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) or ever had an ASCVD procedure; OR

*Patients aged >= 20 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

*Patients aged 40-75 years with a diagnosis of diabetes

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

- All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR

- Patients aged 20 to 75 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

- Patients aged 40-75 years with a diagnosis of diabetes; OR

- Patients aged 40 to 75 with a 10-year ASCVD risk score of >= 20 percent

Percentage of the following patients - all considered at high risk of cardiovascular events - who were prescribed or were on statin therapy during the measurement period:

- All patients who were previously diagnosed with or currently have a diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD), including an ASCVD procedure; OR

- Patients aged 20 to 75 years who have ever had a low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia; OR

- Patients aged 40-75 years with a diagnosis of diabetes; OR

- Patients aged 40 to 75 with a 10-year ASCVD risk score of >= 20 percent.

Measure Scoring Proportion measure Proportion measure Proportion measure Proportion measure
Measure Type Process Process Process Process
Stratification *See CMS347v5.html *See CMS347v6.html

None

None

Risk Adjustment *See CMS347v5.html *See CMS347v6.html

None

None

Rationale *See CMS347v5.html *See CMS347v6.html

"Cardiovascular disease (CVD) is the leading cause of death in the United States, causing approximately 1 of every 3 deaths in the United States in 2015. In 2015, stroke caused approximately 1 of every 19 deaths in the United States and the estimated annual costs for CVD and stroke were $329.7 billion, including $199.2 billion in direct costs (hospital services, physicians and other professionals, prescribed medications, home health care, and other medical durables) and $130.5 billion in indirect costs from lost future productivity (cardiovascular and stroke premature deaths). CVD costs more than any other diagnostic group" (Benjamin et al., 2018).

Data collected between 2011 and 2014 indicates that more than 94.6 million U.S. adults, 20 years or older, had total cholesterol levels equal to 200 mg/dL or more, while almost 28.5 million had levels 240 mg/dL or more (Benjamin et al., 2018). Elevated blood cholesterol is a major risk factor for CVD and statin therapy has been associated with a reduced risk of CVD. Numerous randomized trials have demonstrated that treatment with a statin reduces LDL-C and reduces the risk of major cardiovascular events by approximately 20 percent (Ference, 2015).

In 2018, updated guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults were published (Grundy et al., 2019). This guideline was published by an Expert Panel, which synthesized evidence from randomized controlled trials to identify people most likely to benefit from cholesterol-lowering therapy. The American College of Cardiology (ACC)/American Heart Association (AHA)/Multi-society (MS) Guideline recommendations are intended to provide a strong evidence-based foundation for the treatment of blood cholesterol for the primary and secondary prevention and treatment of ASCVD in patients of all ages. The document concludes that the addition of statin therapy reduces the risk of ASCVD among high-risk individuals, defined as follows: individuals with clinical ASCVD, with LDL-C >= 190 mg/dL, with diabetes, or individuals with >= 20% risk of ASCVD as determined via use of an ASCVD risk estimator derived from the Pooled Cohort Equations (Grundy et al., 2019).

One study surveying U.S. cardiology, primary care, and endocrinology practices found that 1 in 4 guideline-eligible patients were not on a statin and less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment (Navar et al., 2017). In a follow-up study authored by Nanna et al., the same clinics were divided into tertiles based on the percentage of patients with guideline-recommended statin use. The researchers found that patients in the high-tertile clinics were more likely to achieve target LDL-C levels than patients at the low- or mid-tertile clinics, and this held true when patients were stratified by primary and secondary prevention (Nanna et al., 2019a).

Research also indicates that certain populations are far less likely to receive guideline-recommended statin therapy than others. A retrospective study of the National Health and Nutrition Examination Survey found that Black and Hispanic race or ethnicity, low income, lack of health insurance coverage, poor health care access, young age, and female gender are predictors of lower statin utilization (Gu et al., 2018). In particular, there is extensive evidence that women are far less likely than men to be prescribed guideline-recommended statin therapy (Nanna et al., 2019b), despite research showing that female patients with cardiovascular disease derive the same or greater benefit from statin therapy as male patients with cardiovascular disease (Puri et al., 2014).

The Statin Safety Expert Panel that participated in a National Lipid Association (NLA) Statin Safety Task Force meeting in October 2013 reaffirms the general safety of statin therapy. The panel members concluded that for most patients requiring statin therapy, the potential benefits of statin therapy outweigh the potential risks. In general terms, the benefits of statins to prevent non-fatal myocardial infarction, revascularization, stroke, and CVD mortality, far outweigh any potential harm related to the drug (Jacobson, 2014).

"Cardiovascular disease (CVD) is the leading cause of death in the United States, causing approximately 1 of every 3 deaths in the United States in 2015. In 2015, stroke caused approximately 1 of every 19 deaths in the United States and the estimated annual costs for CVD and stroke were $329.7 billion, including $199.2 billion in direct costs (hospital services, physicians and other professionals, prescribed medications, home health care, and other medical durables) and $130.5 billion in indirect costs from lost future productivity (cardiovascular and stroke premature deaths). CVD costs more than any other diagnostic group" (Benjamin et al., 2018).

Data collected between 2011 and 2014 indicates that more than 94.6 million U.S. adults, 20 years or older, had total cholesterol levels equal to 200 mg/dL or more, while almost 28.5 million had levels 240 mg/dL or more (Benjamin et al., 2018). Elevated blood cholesterol is a major risk factor for CVD and statin therapy has been associated with a reduced risk of CVD. Numerous randomized trials have demonstrated that treatment with a statin reduces LDL-C and reduces the risk of major cardiovascular events by approximately 20 percent (Ference, 2015).

In 2018, updated guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults were published (Grundy et al., 2019). This guideline was published by an Expert Panel, which synthesized evidence from randomized controlled trials to identify people most likely to benefit from cholesterol-lowering therapy. The American College of Cardiology (ACC)/American Heart Association (AHA)/Multi-society (MS) Guideline recommendations are intended to provide a strong evidence-based foundation for the treatment of blood cholesterol for the primary and secondary prevention and treatment of ASCVD in patients of all ages. The document concludes that the addition of statin therapy reduces the risk of ASCVD among high-risk individuals, defined as follows: individuals with clinical ASCVD, with LDL-C >= 190 mg/dL, with diabetes, or individuals with >= 20 percent risk of ASCVD as determined via use of an ASCVD risk estimator derived from the Pooled Cohort Equations (Grundy et al., 2019).

One study surveying U.S. cardiology, primary care, and endocrinology practices found that 1 in 4 guideline-eligible patients were not on a statin and less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment (Navar et al., 2017). In a follow-up study authored by Nanna et al., the same clinics were divided into tertiles based on the percentage of patients with guideline-recommended statin use. The researchers found that patients in the high-tertile clinics were more likely to achieve target LDL-C levels than patients at the low- or mid-tertile clinics, and this held true when patients were stratified by primary and secondary prevention (Nanna et al., 2019a).

Research also indicates that certain populations are far less likely to receive guideline-recommended statin therapy than others. A retrospective study of the National Health and Nutrition Examination Survey found that Black and Hispanic race or ethnicity, low income, lack of health insurance coverage, poor health care access, young age, and female gender are predictors of lower statin utilization (Gu et al., 2018). In particular, there is extensive evidence that women are far less likely than men to be prescribed guideline-recommended statin therapy (Nanna et al., 2019b), despite research showing that female patients with cardiovascular disease derive the same or greater benefit from statin therapy as male patients with cardiovascular disease (Puri et al., 2014).

The Statin Safety Expert Panel that participated in a National Lipid Association (NLA) Statin Safety Task Force meeting in October 2013 reaffirms the general safety of statin therapy. The panel members concluded that for most patients requiring statin therapy, the potential benefits of statin therapy outweigh the potential risks. In general terms, the benefits of statins to prevent non-fatal myocardial infarction, revascularization, stroke, and CVD mortality, far outweigh any potential harm related to the drug (Jacobson, 2014).

Clinical Recommendation Statement *See CMS347v5.html *See CMS347v6.html

This electronic clinical quality measure is intended to align with the 2018 ACC/AHA/MS Guideline on the Management of Blood Cholesterol (Grundy et al., 2019), which indicates the use of statins as the first line of cholesterol-lowering medication therapy to lower the risk of ASCVD among at-risk populations.

Recommendations for Management of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults - Statin Treatment:

Secondary Prevention:

1. In patients who are 75 years of age or younger with clinical ASCVD, high-intensity statin therapy should be initiated or continued with the aim of achieving a 50% or greater reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019).

2. In patients with clinical ASCVD in whom high-intensity statin therapy is contraindicated or who experience statin-associated side effects, moderate-intensity statin therapy should be initiated or continued with the aim of achieving a 30% to 49% reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019).

3. In patients older than 75 years of age with clinical ASCVD, it is reasonable to initiate moderate- or high-intensity statin therapy after evaluation of the potential for ASCVD risk reduction, adverse effects, and drug–drug interactions, as well as patient frailty and patient preferences (Class IIa Recommendation), (Grundy et al., 2019).

Primary Prevention

1. In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL or higher (>= 4.9 mmol/L), maximally tolerated statin therapy is recommended. (Class I Recommendation), (Grundy et al., 2019).

2. In adults 40 to 75 years of age with diabetes mellitus, regardless of estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated (Class I Recommendation), (Grundy et al., 2019).

3. To facilitate decisions about preventive interventions, it is recommended to screen for traditional ASCVD risk factors and apply the race- and sex-specific Pooled Cohort Equations (PCE) to estimate 10-year ASCVD risk for asymptomatic adults 40 to 75 years of age. The higher the estimated risk, the more likely the patient is to benefit from statin treatment (Grundy et al., 2019).

The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5% to less than 10% has at least a small net benefit (USPSTF 2022).

Statin Safety and Statin-Associated Side Effects

A clinician–patient risk discussion is recommended before initiation of statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, statin–drug interactions, and safety, while emphasizing that side effects can be addressed successfully (Class I Recommendation), (Grundy et al., 2019).

This electronic clinical quality measure is intended to align with the 2018 ACC/AHA/MS Guideline on the Management of Blood Cholesterol (Grundy et al., 2019), which indicates the use of statins as the first line of cholesterol-lowering medication therapy to lower the risk of ASCVD among at-risk populations.

Recommendations for Management of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults - Statin Treatment:

Secondary Prevention:

1. In patients who are 75 years of age or younger with clinical ASCVD, high-intensity statin therapy should be initiated or continued with the aim of achieving a 50 percent or greater reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019).

2. In patients with clinical ASCVD in whom high-intensity statin therapy is contraindicated or who experience statin-associated side effects, moderate-intensity statin therapy should be initiated or continued with the aim of achieving a 30 to 49 percent reduction in LDL-C levels (Class I Recommendation), (Grundy et al., 2019).

3. In patients older than 75 years of age with clinical ASCVD, it is reasonable to initiate moderate- or high-intensity statin therapy after evaluation of the potential for ASCVD risk reduction, adverse effects, and drug–drug interactions, as well as patient frailty and patient preferences (Class IIa Recommendation), (Grundy et al., 2019).

Primary Prevention

1. In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL or higher (>= 4.9 mmol/L), maximally tolerated statin therapy is recommended. (Class I Recommendation), (Grundy et al., 2019).

2. In adults 40 to 75 years of age with diabetes mellitus, regardless of estimated 10-year ASCVD risk, moderate-intensity statin therapy is indicated (Class I Recommendation), (Grundy et al., 2019).

3. To facilitate decisions about preventive interventions, it is recommended to screen for traditional ASCVD risk factors and apply the race- and sex-specific Pooled Cohort Equations (PCE) to estimate 10-year ASCVD risk for asymptomatic adults 40 to 75 years of age. The higher the estimated risk, the more likely the patient is to benefit from statin treatment (Grundy et al., 2019).

The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5 percent to less than 10 percent has at least a small net benefit (USPSTF 2022).

Statin Safety and Statin-Associated Side Effects

A clinician–patient risk discussion is recommended before initiation of statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, statin–drug interactions, and safety, while emphasizing that side effects can be addressed successfully (Class I Recommendation), (Grundy et al., 2019).

Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Definition *See CMS347v5.html *See CMS347v6.html

Clinical atherosclerotic cardiovascular disease (ASCVD) includes:

- Acute coronary syndromes

- History of myocardial infarction

- Stable or unstable angina

- Coronary or other arterial revascularization

- Stroke or transient ischemic attack (TIA)

- Peripheral arterial disease of atherosclerotic origin

Lipoprotein density cholesterol (LDL-C) result:

- A fasting or non-fasting LDL-C laboratory test performed and direct or calculated test result documented in the medical record. When both direct and calculated test results are available on the same day, the direct LDL-C test result should be used.

Statin therapy:

- Administration of one or more of a group of medications that are used to lower plasma lipoprotein levels in the treatment of hyperlipoproteinemia.

Statin Medication Therapy List (NOTE: List does NOT include dosage):

[Generic name] (Brand or trade name) and (-) Medication type, if applicable:

[Atorvastatin] (Lipitor) - Statin

[Fluvastatin] (Lescol XL or Lescol) - Statin

[Lovastatin (Mevinolin)](Mevacor or Altoprev) -Statin

[Pitavastatin] (Livalo or Zypitamag or Nikita) - Statin

[Pravastatin Sodium] (Pravachol) - Statin

[Rosuvastatin Calcium] (Crestor) - Statin

[Simvastatin] (Zocor) - Statin

[Amlodipine Besylate/Atorvastatin Calcium] (Caduet) – Fixed Dose Combination

[Ezetimibe / Rosuvastatin] (Roszet) – Fixed Dose Combination

[Ezetimibe/Simvastatin] (Vytorin) – Fixed Dose Combination

Statin-Associated Muscle Symptoms (SAMS) – The 2018 ACC/AHA/MS Guideline (Grundy et al., 2019) includes the following SAMS: myalgias, myositis, myopathy, or statin-associated autoimmune myopathy. Patients who experience significant or repeated statin-associated muscle symptoms may prefer not to take or continue statin therapy and therefore may be removed from the denominator.

Clinical atherosclerotic cardiovascular disease (ASCVD) includes:

- Acute coronary syndromes

- History of myocardial infarction

- Stable or unstable angina

- Coronary or other arterial revascularization

- Stroke or transient ischemic attack (TIA)

- Peripheral arterial disease of atherosclerotic origin

Lipoprotein density cholesterol (LDL-C) result:

- A fasting or non-fasting LDL-C laboratory test performed and direct or calculated test result documented in the medical record. When both direct and calculated test results are available on the same day, the direct LDL-C test result should be used.

Statin therapy:

- Administration of one or more of a group of medications that are used to lower plasma lipoprotein levels in the treatment of hyperlipoproteinemia.

Statin Medication Therapy List (NOTE: List does NOT include dosage):

[Generic name] (Brand or trade name) and (-) Medication type, if applicable:

[Atorvastatin] (Lipitor) - Statin

[Fluvastatin] (Lescol XL or Lescol) - Statin

[Lovastatin (Mevinolin)](Mevacor or Altoprev) - Statin

[Pitavastatin] (Livalo or Zypitamag or Nikita) - Statin

[Pravastatin Sodium] (Pravachol) - Statin

[Rosuvastatin Calcium] (Crestor) - Statin

[Simvastatin] (Zocor) - Statin

[Amlodipine Besylate/Atorvastatin Calcium] (Caduet) – Fixed Dose Combination

[Ezetimibe / Rosuvastatin] (Roszet) – Fixed Dose Combination

[Ezetimibe/Simvastatin] (Vytorin) – Fixed Dose Combination

Statin-Associated Muscle Symptoms (SAMS) – The 2018 ACC/AHA/MS Guideline (Grundy et al., 2019) includes the following SAMS: myalgias, myositis, myopathy, or statin-associated autoimmune myopathy. Patients who experience significant or repeated statin-associated muscle symptoms may prefer not to take or continue statin therapy and therefore may be removed from the denominator.

Guidance

Initial Population Guidance:

The initial population covers three distinct populations. Use the following process to prevent counting patients more than once.

Initial Population 1:

All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure, before the end of the measurement period

-If YES, meets Initial Population 1 risk category

-If NO, screen for next risk category

Initial Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

-If YES, meets Initial Population 2 risk category

-If NO, screen for next risk category

Initial Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period

-If YES, meets Initial Population 3 risk category

-If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion

Initial Population Guidance for Encounter:

In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented LDL-C level recorded as follows:

To meet Initial Population 1:

There is no LDL-C result required.

To meet Initial Population 2:

If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Initial Population 3:

There is no LDL-C result required.

Numerator instructions and guidance:

-Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

-ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

-Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

-Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

-Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception.

-There is only one performance rate calculated for this measure: the weighted average of the three populations.

-Adherence to statin therapy is not calculated in this measure.

-It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list).

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

Initial Population Guidance:

The initial population covers three distinct populations. Use the following process to prevent counting patients more than once.

Initial Population 1:

All patients who have an active diagnosis of clinical ASCVD anytime during the measurement period or ever had an ASCVD procedure.

-If YES, meets Initial Population 1 risk category

-If NO, screen for next risk category

Initial Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

-If YES, meets Initial Population 2 risk category

-If NO, screen for next risk category

Initial Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period

-If YES, meets Initial Population 3 risk category

-If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion

Initial Population Guidance for Encounter:

In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented LDL-C level recorded as follows:

To meet Initial Population 1:

There is no LDL-C result required.

To meet Initial Population 2:

If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Initial Population 3:

There is no LDL-C result required.

Numerator instructions and guidance:

-Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

-ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

-Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

-Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

-Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception.

-There is only one performance rate calculated for this measure: the weighted average of the three populations.

-Adherence to statin therapy is not calculated in this measure.

-It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list).

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Initial Population Guidance:

The initial population covers four distinct populations. Use the following process to prevent counting patients more than once.

Initial Population 1:

All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure before the end of the measurement period.

- If YES, meets Initial Population 1 risk category

- If NO, screen for next risk category

Initial Population 2:

Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

- If YES, meets Initial Population 2 risk category

- If NO, screen for next risk category

Initial Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period.

- If YES, meets Initial Population 3 risk category

- If NO, screen for next risk category

Initial Population 4:

Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score of >= 20 percent during the measurement period.

- If YES, meets Initial Population 4 risk category

- If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion.

Initial Population Guidance for Encounter:

In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit.

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented LDL-C level recorded as follows:

To meet Initial Population 1:

There is no LDL-C result required.

To meet Initial Population 2:

If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Initial Population 3:

There is no LDL-C result required.

To meet Initial Population 4:

There is no LDL-C result required.

The 10-year ASCVD risk assessment options:

The 10-year ASCVD risk score is calculated using the Pooled Cohort Equations: 1) the 2013 ACC/AHA ASCVD Risk Estimator (maps to LOINC Code 79423-0) OR 2) the ACC Risk Estimator Plus (maps to LOINC Code 99055-6). If your EHR does not have either of these risk calculators, we recommend that you use the on-line versions. The 10-year ASCVD risk score (quantitative result, i.e., result.value, "%") must be documented in a structure field. The 10-year ASCVD risk assessment must be performed during the measurement period.

 

Numerator instructions and guidance:

- Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

- ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

- Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

- Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

- Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception.

- There is only one performance rate calculated for this measure: the weighted average of the four populations.

- Adherence to statin therapy is not calculated in this measure.

- It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list).

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure.

This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Initial Population Guidance:

The initial population covers four distinct populations. Use the following process to prevent counting patients more than once.

Initial Population 1:

All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure before the end of the measurement period.

- If YES, meets Initial Population 1 risk category.

- If NO, screen for next risk category.

Initial Population 2:

Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

- If YES, meets Initial Population 2 risk category.

- If NO, screen for next risk category.

Initial Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with an active diagnosis of Type 1 or Type 2 diabetes at any time during the measurement period.

- If YES, meets Initial Population 3 risk category.

- If NO, screen for next risk category.

Initial Population 4:

Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score of >= 20 percent during the measurement period.

- If YES, meets Initial Population 4 risk category.

- If NO, patient does NOT meet Initial Population criteria and is NOT eligible for measure inclusion.

Initial Population Guidance for Encounter:

In order for the patient to be included in the Initial Population, the patient must have ONE initial population-eligible visit, defined as follows: outpatient visit, initial or established office visit, face-to-face interaction, preventive care services, or annual wellness visit.

LDL-C Laboratory test result options:

The measure can be reported for all patients with a documented LDL-C level recorded as follows:

To meet Initial Population 1:

There is no LDL-C result required.

To meet Initial Population 2:

If a patient has ANY previous laboratory result of LDL-C >= 190 mg/dL, report the highest value >= 190 mg/dL.

To meet Initial Population 3:

There is no LDL-C result required.

To meet Initial Population 4:

There is no LDL-C result required.

The 10-year ASCVD risk assessment options:

The 10-year ASCVD risk score is calculated using the Pooled Cohort Equations: 1) the 2013 ACC/AHA ASCVD Risk Estimator (maps to LOINC Code 79423-0) OR 2) the ACC Risk Estimator Plus (maps to LOINC Code 99055-6). If your EHR does not have either of these risk calculators, we recommend that you use the on-line versions. The 10-year ASCVD risk score (quantitative result, i.e., result.value, "%") must be documented in a structured field. The 10-year ASCVD risk assessment must be performed during the measurement period.

 

Numerator instructions and guidance:

- Current statin therapy use must be documented in the patient's current medication list or ordered during the measurement period.

- ONLY statin therapy meets the measure Numerator criteria (NOT other cholesterol lowering medications).

- Prescription or order does NOT need to be linked to an encounter or visit; it may be called to the pharmacy.

- Statin medication "samples" provided to patients can be documented as "current statin therapy" if documented in the medication list in health/medical record.

- Patients who meet the denominator criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure unless they have an allowable denominator exception. Patients with an allowable denominator exception should be removed from the denominator of the measure and reported as a valid exception.

- There is only one performance rate calculated for this measure: the weighted average of the four populations.

- Adherence to statin therapy is not calculated in this measure.

- It may not be appropriate to prescribe statin therapy for some patients (see exceptions and exclusions for the complete list).

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2018 ACC/AHA/MS Guidelines (Grundy et al., 2019) defines recommended intensity of statin therapy on the basis of the average expected LDL-C response to specific statin and dose. Although intensity of statin therapy is important in managing cholesterol, this measure assesses prescription of ANY statin therapy, irrespective of intensity. Assessment of appropriate intensity and dosage documentation added too much complexity to allow inclusion of statin therapy intensity in the measure at this time.

Lifestyle modification coaching:

A healthy lifestyle is important for the prevention of cardiovascular disease. However, lifestyle modification monitoring and documentation added too much complexity to allow its inclusion in the measure at this time.

Millimoles per liter (mmol/L) should be converted to milligrams per deciliter (mg/dL) for reporting this measure.

This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Initial Population

Population 1:

All patients who were previously diagnosed with or currently have an active diagnosis of clinical ASCVD, including an ASCVD procedure

Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia

Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes

Population 1:

All patients who have an active diagnosis of clinical ASCVD or ever had an ASCVD procedure.

Population 2:

Patients aged >= 20 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes.

Population 1:

All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure.

Population 2:

Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes.

Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score (i.e., 2013 ACC/AHA ASCVD Risk Estimator or the ACC Risk Estimator Plus) of >= 20 percent during the measurement period.

Population 1:

All patients who were previously diagnosed with or currently have a diagnosis of clinical ASCVD, including an ASCVD procedure.

Population 2:

Patients aged 20 to 75 years at the beginning of the measurement period who have ever had a laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial hypercholesterolemia.

Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes.

Population 4: Patients aged 40 to 75 at the beginning of the measurement period with a 10-year ASCVD risk score (i.e., 2013 ACC/AHA ASCVD Risk Estimator or the ACC Risk Estimator Plus) of >= 20 percent during the measurement period.

Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions

Patients who have a diagnosis of pregnancy at any time during the measurement period

Patients who are breastfeeding at any time during the measurement period

Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period

Patients who are breastfeeding at any time during the measurement period.

Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.

Patients who are breastfeeding at any time during the measurement period.

Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.

Patients who are breastfeeding at any time during the measurement period.

Patients who have a diagnosis of rhabdomyolysis at any time during the measurement period.

Numerator

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period

Patients who are actively using or who receive an order (prescription) for statin therapy at any time during the measurement period

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Not Applicable

Denominator Exceptions

Patients with statin-associated muscle symptoms or an allergy to statin medication

Patients who are receiving palliative or hospice care

Patients with active liver disease or hepatic disease or insufficiency

Patients with end-stage renal disease (ESRD)

Patients with statin-associated muscle symptoms or an allergy to statin medication.

Patients who are receiving palliative or hospice care.

Patients with active liver disease or hepatic disease or insufficiency.

Patients with end-stage renal disease (ESRD).

Patients with documentation of a medical reason for not being prescribed statin therapy.

Patients with statin-associated muscle symptoms or an allergy to statin medication.

Patients who are receiving palliative or hospice care.

Patients with active liver disease or hepatic disease or insufficiency.

Patients with end-stage renal disease (ESRD).

Patients with documentation of a medical reason for not being prescribed statin therapy.

Patients with statin-associated muscle symptoms or an allergy to statin medication.

Patients who are receiving palliative or hospice care.

Patients with active liver disease or hepatic disease or insufficiency.

Patients with end-stage renal disease (ESRD).

Patients with documentation of a medical reason for not being prescribed statin therapy.

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eCQM Jira Issue Tracker

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated Measure Developer.

    Measure Section: Measure Developer

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Annual Update

  • Updated Rationale section of header to reflect most current literature.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • Added clinically appropriate brand name statin drugs to the Statin Medication Therapy List in the header Definitions section to complete the list of appropriate statin therapy drugs to meet the measure numerator. Revised category of drugs to reflect that combination drugs must be of a fixed dose.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Removed definition for statin intolerance and added a definition for Statin-Associated Muscle Symptoms to align with the updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Updated Definitions header section for LDL-C result to allow either fasting or nonfasting and either direct or calculated LDL-C results to calculate the measure.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Updated Guidance language to reflect that the denominator equals one of three new Initial Populations. Updated Guidance language to remove the denominator exception for Population 3 for patients who have an LDL-C < 70 to align with the updated 2018 ACC/AHA Cholesterol Guidelines. Added language to clarify that statins may not be appropriate for all patients, as specified in the denominator exceptions.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated numerator guidance to provide clarity for implementers about when an exception would be appropriate.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated Denominator header statement to set Denominator equal to Initial Population to reduce the number of patients counted in Population 1 due to the removal of the age restriction.

    Measure Section: Denominator

    Source of Change: Expert Work Group Review

  • Added language to Denominator Exclusions header section to clarify that exclusions must be active during the measurement period.

    Measure Section: Denominator Exclusions

    Source of Change: Expert Work Group Review

  • Revised language in Numerator header statement about timing to align with the rest of the measure.

    Measure Section: Numerator

    Source of Change: Expert Work Group Review

  • Removed 'statin intolerance' and replaced with 'statin-associated muscle symptoms' in the first Denominator Exception and removed exception for patients with diabetes who have an LDL-C result < 70 to align with the updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Updated measure Description, Rationale, and Clinical Recommendations header statements to align with updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

  • Updated age thresholds in Populations 1 and 2, removed 'pure hypercholesterolemia' from Population 2, and removed LDL-C requirement from Population 3 in Rate Aggregation and Initial Population header sections to align with updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

  • Added the phrase 'including an ASCVD procedure' to Population 1 throughout the measure header to align the header with the existing measure logic that patients who have an ASCVD procedure are included in Population 1.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Removed the phrase 'fasting or direct' throughout the measure to clarify that any LDL-C results can be used to calculate the measure.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

Logic

  • Updated Initial Population to revise age thresholds in Populations 1 and 2, removed 'pure hypercholesterolemia' from Initial Population 2 logic, and removed LDL-C requirement from Initial Population 3 logic to align with updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Initial Population

    Source of Change: Expert Work Group Review

  • Updated Denominator logic statements to set Denominator equal to Initial Population to reduce the number of patients counted in Population 1 due to the removal of the age restriction.

    Measure Section: Denominator

    Source of Change: Expert Work Group Review

  • Removed exception for allergy or intolerance to statin and added exception for statin-associated muscle symptoms to align with the updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Removed exception for patients with diabetes who have an LDL-C < 70 from Denominator Exceptions logic to align with updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

  • Updated definition for Denominator Exceptions, removed definition for Allergy or Intolerance to Statin, and added definitions for Has Allergy to Statin and Has Statin Associated Muscle Symptoms to align with the updated 2018 ACC/AHA Cholesterol Guidelines.

    Measure Section: Definitions

    Source of Change: Expert Work Group Review

  • Updated definitions for Denominator 1, 2, and 3 to set them equal to Initial Population to reduce the number of patients counted in Population 1 due to the removal of the age restriction. Removed definition for Denominator Exceptions 3 because Denominator Exceptions 3 equals Denominator Exceptions for Populations 1 and 2 when the last exception for LDL-C result is removed. Removed definition for Highest LDL Result because the LDL-C requirement was removed from Population 3. Removed Initial Population definition because the measure was revised to use three Initial Populations. Added definitions for Initial Population 1, 2, and 3 to allow for greater specificity after the age threshold was removed from Population 1. Removed definition for Most Recent LDL Result Within 3 Years because the LDL-C requirement was removed from Population 3. Added definition for Patients Age 20 or Older to align with new age range for Population 2. Added definition for Patients Age 20 Years and Older with LDL Cholesterol Result >= 190 to align with new age range for Population 2 and to clarify that patients can also have hypercholesterolemia and cannot have ASCVD. Added definition for Patients Age 40 50 75 with Diabetes to revise the logic because the LDL-C result requirement was removed from Population 3 and to clarify that patients in this population cannot have hypercholesterolemia or LDL-C > 190 or ASCVD.

    Measure Section: Definitions

    Source of Change: Expert Work Group Review

  • Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Liver Disease (2.16.840.1.113762.1.4.1047.42): Added 3 ICD-10-CM codes (K74.00, K74.01, K74.02) based on terminology update. Deleted 1 ICD-10-CM code (K74.0) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set (2.16.840.1.113762.1.4.1047.100): Renamed to Familial Hypercholesterolemia. Deleted 2 SNOMED CT codes (267432004, 414416008) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 1 ICD-10-CM code (E78.00) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (Jira): CQM-3483

  • Value set Breastfeeding (2.16.840.1.113762.1.4.1047.73): Added 1 SNOMED CT code (866041003) based on terminology update. Deleted 1 SNOMED CT code (169750002) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Pregnancy or Other Related Diagnoses (2.16.840.1.113883.3.600.1.1623): Added 5 ICD-10-CM codes (O99.891, O99.892, O99.893, O34.218, O34.22) based on terminology update. Deleted 2 ICD-10-CM codes (A34, O99.89) based on terminology update. Added 1 SNOMED CT code (169488004) based on terminology update. Deleted 1 SNOMED CT code (102873005) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Atherosclerosis and Peripheral Arterial Disease (2.16.840.1.113762.1.4.1047.21): Added 3 SNOMED CT codes (792843009, 792844003, 792845002) based on terminology update. Deleted 4 SNOMED CT codes (145891000119104, 149841000119109, 5111000119102, 5561000119107) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Ischemic Heart Disease or Other Related Diagnoses (2.16.840.1.113762.1.4.1047.46): Added 1 SNOMED CT code (413444003) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 SNOMED CT codes (210078001, 473393007, 52674009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (Jira): CQM-3482

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 37 SNOMED CT codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 12 SNOMED CT codes (421920002, 4783006, 75682002, 76751001, 769219006, 190388001, 190390000, 395204000, 421750000, 422014003, 703138006, 781000119106) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set High Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1572): Deleted 1 RxNorm code (757705) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set LDL Cholesterol (2.16.840.1.113883.3.526.3.1573): Added 2 LOINC codes (96259-7, 96597-0) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Low Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1574): Deleted 1 RxNorm code (757702) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Moderate Intensity Statin Therapy (2.16.840.1.113883.3.526.3.1575): Deleted 2 RxNorm codes (757703, 757704) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Added value set Statin Associated Muscle Symptoms (2.16.840.1.113762.1.4.1108.85) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Feb 13, 2024