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Preventive Care and Screening: Influenza Immunization

Last updated: September 14, 2018

CMS Measure ID: CMS147v8
Version: 8
NQF Number: 0041
Measure Description:

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

Initial Patient Population:

All patients aged 6 months and older seen for a visit during the measurement period

Denominator Statement:

Equals Initial Populationinfo-icon and seen for a visit between October 1 and March 31

Denominator Exclusions:

None

Numerator Statement:

Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Documentation of medical reason(s) for not receiving influenza immunization (eg, patient allergy, other medical reasons).

Documentation of patient reason(s) for not receiving influenza immunization (eg, patient declined, other patient reasons).

Documentation of system reason(s) for not receiving influenza immunization (eg, vaccine not available, other system reasons).

Measure Steward: PCPI(R) Foundation (PCPI[R])
Domain: Community/Population Health
Previous Version:
Improvement Notation:

Higher score indicates better quality

Guidance:

The timeframe for the visit during the Encounter, Performed: Encounter-Influenza or Procedure, Performed: Peritoneal Dialysis or Procedure, Performed: Hemodialysis in the Population Criteria-Denominatorinfo-icon, refers to the influenza season defined by the measure: October through March (October 1 for the year prior to the start of the reporting period through March 31 during the reporting period). The Encounter-Influenza Grouping OID detailed in the data criteria section below is comprised of several individual OIDs of different encounter types. The individual OIDs are included in the value setinfo-icon and should be reviewed to determine that an applicable visit occurred during the timeframe for Encounter, Performed: Encounter-Influenza as specified in the denominator.

To enable reporting of this measure at the close of the reporting period, this measure will only assess the influenza season that ends in March of the reporting period. The subsequent influenza season (ending March of the following year) will be measured and reported in the following year.

To account for the majority of reporting years' appropriate flu season duration, the measure logic will look at the first 89 days of the measurement period for the appropriate criteria and actions to be present/performed (January 1 through March 31). The measure developerinfo-icon believes it is best to keep the logic as static as possible from one reporting year to the next. Therefore, during leap years, only encounters that occur through March 30 will be counted in the denominator.

As a result of updated CDC/ACIP guidelines which include the interim recommendation that live attenuated influenza vaccine (LAIV) should not be used due to low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013-14 and 2015-16 seasons, the measure specificationsinfo-icon have been updated and no longer include LAIV or intranasal flu vaccine as an option for numeratorinfo-icon eligibility.

Quality ID: 110
Meaningful Measure: Preventive Care

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Updated Clinical Recommendation Statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated Reference.

    Measure Section: Reference

    Source of Change: Measure Lead

Logic

  • Added 'AuthorDateTime' attribute to QDMinfo-icon datatypes that include negation rationale: ‘Diagnostic, Performed’, ‘Intervention Performed’, ‘Encounter, Performed’, ‘Laboratory Test, Performed’, ‘Medication, Administered’, ‘Physical Exam, Performed’, ‘Procedure, Performed’, ‘Substance Administered’ to conform with QDM 5.3 changes.

    Measure Section: Denominator Exceptionsinfo-icon

    Source of Change: Standards Update

  • Replaced 'Allergy, Intolerance' datatypes with 'Allergy/Intolerance' category to conform with QDM 5.3 changes.

    Measure Section: Denominator Exceptions

    Source of Change: Standards Update

  • Added supplemental timing attributes to most datatypes in QDM 5.3 to facilitate accurate retrieval of time related information within CQLinfo-icon logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Removed the 'Face-To-Face Interaction' data element and added relevant SNOMED codes to the Encounter Grouping value setsinfo-icon to better align between the SNOMED and CPT encounter codes.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

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

  • Value set Patient Reason (2.16.840.1.113883.3.526.3.1008): Deleted 1 SNOMEDCT code (385648002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Encounter-Influenza (2.16.840.1.113883.3.526.3.1252): Removed SNOMED extensional Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.11.1216). Added Office Visit SNOMED extensional (2.16.840.1.113883.3.464.1003.101.11.1264), Outpatient Consultation SNOMED extensional (2.16.840.1.113883.3.464.1003.101.11.1266), Nursing Facility Visit SNOMED extensional (2.16.840.1.113883.3.464.1003.101.11.1261), Care Services in Long-Term Residential Facility SNOMED extensional (2.16.840.1.113883.3.464.1003.101.11.1262), and Home Healthcare Services SNOMED extensional (2.16.840.1.113883.3.464.1003.101.11.1265).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Influenza Vaccine (2.16.840.1.113883.3.526.3.1254): Added 1 CVX code (186) and deleted 1 CVX code (153).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Influenza Vaccination (2.16.840.1.113883.3.526.3.402): Added 1 CPT code (90756).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1264) including 7 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1266) including 3 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1261) including 2 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Care Services in Long-Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1262) including 2 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1265) including 11 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Removed Face-to-Face Interaction.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources