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Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

Last updated: May 3, 2018

CMS Measure ID: CMS122v5
Version: 5
NQF Number: 0059
Measure Description:

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period

Initial Patient Population:

Patients 18-75 years of age with diabetes with a visit during the measurement period

Denominator Statement:

Equals Initial Populationinfo-icon

Denominator Exclusions:

None

Numerator Statement:

Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Effective Clinical Care
Next Version:
Improvement Notation:

Lower score indicates better quality

Guidance:

Patient is numeratorinfo-icon compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.

Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominatorinfo-icon of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.

Notes: Value Set content updated
Quality ID: 1
High Priority Measure: Yes
Data Submission Method: Claims,CMS Web Interface,EHR,Registry
Specialty Measure Set: Internal Medicine,Preventive Medicine,General Practice/Family Medicine

Specifications

Release Notes

Header

  • Updated Clinical Recommendation Statement.

    Section: Clinical Recommendation Statement

    Source: Measure Lead

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Clarified when the HBA1c test result was in the medical record, it could be used to determine numeratorinfo-icon compliance.

    Section: Guidance

    Source: Measure Lead

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

  • Updated measure name to harmonize with the endorsed measure name.

    Section: Title

    Source: Measure Lead

Logic

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDMinfo-icon 4.2 changes.

    Section: Initial Populationinfo-icon

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

Value Setinfo-icon

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 11 ICD9CM codes (250.40, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00).

    Section: None

    Source: None

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 156 ICD10CM codes.

    Section: None

    Source: ICD-10 Addendum

External Resources