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Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Last updated: September 14, 2018

CMS Measure ID: CMS347v2
Version: 2
NQF Number: None
Measure 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:

*Adults aged >= 21 years who were previously diagnosed with or currently have an active diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD); OR

*Adults aged >= 21 years who have ever had a fasting or direct low-density lipoprotein cholesterol (LDL-C) level >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia; OR

*Adults aged 40-75 years with a diagnosis of diabetes with a fasting or direct LDL-C level of 70-189 mg/dL

Initial Patient Population:

All patients aged 21 years and older at the beginning of the measurement period with a patient encounter during the measurement period

Denominator Statement:

All patients who meet one or more of the following criteria (considered at high risk for cardiovascular events, under ACC/AHA guidelines):

1) Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD diagnosis

2) Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory result of LDL-C >=190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

3) Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of 70-189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

Denominator Exclusions:

Patients who have a diagnosis of pregnancy

Patients who are breastfeeding

Patients who have a diagnosis of rhabdomyolysis

Numerator Statement:

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

Numerator Exclusions:

None

Denominator Exceptions:

Patients with adverse effect, allergy, or intolerance to statin medication

Patients who are receiving palliative care

Patients with active liver disease or hepatic disease or insufficiency

Patients with end-stage renal disease (ESRD)

Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy

Measure Steward: Centers for Medicare & Medicaid Services (CMS)
Domain: Effective Clinical Care
Previous Version:
Improvement Notation:

Higher score indicates better quality

Guidance:

Numeratorinfo-icon 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 denominatorinfo-icon criteria for inclusion, but are not prescribed or using statin therapy, will NOT meet performance for this measure.

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

Denominator Guidance:

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

Denominator Population 1:

Patients aged >= 21 years at the beginning of the measurement period with clinical ASCVD

-If YES, meets Denominator Population 1 risk category

-If NO, screen for next risk category

Denominator Population 2:

Patients aged >= 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory test result of LDL-C >= 190 mg/dL or were previously diagnosed with or currently have an active diagnosis of familial or pure hypercholesterolemia

-If YES, meets Denominator Population 2 risk category

-If NO, screen for next risk category

Denominator Population 3:

Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with a LDL-C result of 70 -189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period

-If YES, meets Denominator Population 3 risk category

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

Denominator Guidance for Encounter:

-In order for the patient to be included in the denominator, the patient must have ONE denominator-eligible visit, defined as follows:

--Outpatient encounter visit type

--Encounter, performed: 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 fasting or direct LDL-C level recorded as follows:

To meet Denominator Population 1:

There is no LDL-C result required.

To meet Denominator Population 2:

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

To meet Denominator Population 3:

If a patient has more than one LDL-C result during the measurement period or during the two years before the start of the measurement period, report the highest level recorded during either time. The Denominator Exceptioninfo-icon, Patients with diabetes who have the most recent fasting or direct LDL-C laboratory test result < 70 mg/dL and are not taking statin therapy applies only to Denominator Population 3.

Intensity of statin therapy in primary and secondary prevention:

The expert panel of the 2013 ACC/AHA Guidelines (Stone et al., 2013) 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.

Quality ID: 438
Meaningful Measure: Management of Chronic Conditions

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 link to guideline reference with working link to full text article.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Removed [Ezetimibe/Atorvastatin] (Liptruzet) from definition of Statin Medication Therapy List since the medication is no longer available to prescribe.

    Measure Section: Definition

    Source of Change: Measure Lead

Logic

  • Replaced 'Adverse Reaction' datatype with 'Adverse Event' category to conform with QDMinfo-icon 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

  • Revised palliative care logic in Denominator Exceptions and replaced 'Intervention, Performed' with 'Intervention, Order' for palliative care to better align with the palliative care concept across measures.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • 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

  • 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 setsinfo-icon.

  • Value set Palliative care encounter (2.16.840.1.113883.3.600.1.1575): Added Palliative care encounter.

    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 CABG Surgeries (2.16.840.1.113883.3.666.5.694): Added 163 ICD10PCS codes. Added 11 SNOMEDCT codes (175066001, 419132001, 252427007, 438530000, 450506009, 440332008, 175036008, 175037004, 175038009, 175039001, 175040004).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Deleted 17 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Moderate intensity statin therapy (2.16.840.1.113762.1.4.1047.98): Added 2 RXNORM codes (2001262, 2001266).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Low intensity statin therapy (2.16.840.1.113762.1.4.1047.107): Added 1 RXNORM code (2001254).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Carotid Intervention (2.16.840.1.113883.3.117.1.7.1.204): Added 16 ICD10PCS codes.

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set PCI (2.16.840.1.113762.1.4.1045.67): Added 1 SNOMEDCT code (737085003).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • 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

  • Value set Pregnancy Dx (2.16.840.1.113883.3.600.1.1623): Added 6 ICD10CM codes (O86.00, O86.01, O86.02, O86.03, O86.04, O86.09) and deleted 1 ICD10CM code (O86.0).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Cerebrovascular disease, Stroke, TIA (2.16.840.1.113762.1.4.1047.44): Added 2 ICD10CM codes (I63.81, I63.89) and deleted 1 ICD10CM code (I63.8).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Added 36 SNOMEDCT codes.

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set CABG Surgeries (2.16.840.1.113883.3.666.5.694): Deleted 4 SNOMEDCT codes (175022003, 175024002, 175025001, 175026000).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources