eCQM Title

Diabetes: Eye Exam

CMS ID

131

eCQM Version Number

14.0.000

CBE Number

Not Applicable

GUID

d90bdab4-b9d2-4329-9993-5c34e2c0dc66

Measurement Period

January 1, 2026 through December 31, 2026

Measure Steward

National Committee for Quality Assurance

Measure Developer

National Committee for Quality Assurance

Endorsed By

None

Description

Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of the measure or specification. 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. NCQA holds a copyright in the Measure. The Measure may be used for internal, noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. All other uses, including a commercial use (including but not limited to vendors using or embedding the measures and specifications into any product or service to calculate measure results for customers for any purpose), must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2025 National Committee for Quality Assurance. All Rights Reserved.

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 2025. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use.

Some measure specifications contain coding from LOINC(R) (https://loinc.org). The LOINC table, LOINC codes, LOINC panels and form file, LOINC linguistic variants file, LOINC/RSNA Radiology Playbook, and LOINC/IEEE Medical Device Code Mapping Table are copyright 2004-2025 Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee, and are available at no cost under the license at https://loinc.org/kb/license/.

Some measures use RxNorm, a standardized nomenclature and coding for clinical drugs and drug delivery devices, which is made publicly available courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services. NLM is not responsible for the measures and does not endorse or recommend this or any other product.

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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

None

Risk Adjustment

None

Rate Aggregation

None

Rationale

Diabetes is the eighth leading cause of death in the United States. In 2021, diabetes affected more than 38 million Americans (11.6 percent of the U.S. population) and killed more than 103,000 people (American Diabetes Association [ADA], 2024). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (Centers for Disease Control and Prevention [CDC], 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b).

In 2022, diabetes cost the U.S. an estimated $413 billion: $307 billion in direct medical costs and $106 billion in reduced productivity. The direct medical cost of diabetes increased by 7% between 2017 and 2022 (Parker et al., 2022). 

Diabetes is the leading cause of new cases of blindness among adults aged 18–64 years (CDC, 2024). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020).

Clinical Recommendation Statement

American Diabetes Association (2024):

- Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B)

- Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B)

- If there is no evidence of retinopathy for one or more annual eye exams and glycemia is well controlled, then screening every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B)

Improvement Notation

Higher score indicates better quality

Reference

Reference Type: CITATION

Reference Text: 'American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Suppl. 1):S231–S243'

Reference

Reference Type: CITATION

Reference Text: 'American Diabetes Association. (2024). Statistics About Diabetes. Retrieved from https://diabetes.org/about-diabetes/statistics/about-diabetes'

Reference

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2020). Common Eye Disorders and Diseases. Retrieved from https://www.cdc.gov/visionhealth/basics/ced/index.html'

Reference

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2022a). What is Diabetes? Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html'

Reference

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2022b). National Diabetes Statistics Report, 2021. US Dept of Health and Human Services. Retrieved from https://www.cdc.gov/diabetes/library/reports/reportcard.html'

Reference

Reference Type: Citation

Reference Text: 'Centers for Disease Control and Prevention. (2024). National Diabetes Statistics Report. Retrieved from https://www.cdc.gov/diabetes/php/data-research/index.html'

Reference

Reference Type: CITATION

Reference Text: 'Parker E, Lin J, Mahoney T, et al. Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26-43. doi:10.2337/dci23-0085'

Definition

None

Guidance

The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were analyzed by a system that provides an autonomous artificial intelligence (AI) calculation.

This eCQM is a patient-based measure.
 
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

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

Denominator

Equals Initial Population

Denominator Exclusions

Exclude patients who are in hospice care for any part of the measurement period.

Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:
- Advanced illness diagnosis during the measurement period or the year prior
- OR taking dementia medications during the measurement period or the year prior

Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. 

Exclude patients receiving palliative care for any part of the measurement period.

Exclude patients who have bilateral absence of eyes any time during the patient’s history through the end of the measurement period.

Numerator

Patients with an eye screening for diabetic retinal disease. This includes patients with diabetes who had one of the following:
- A diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period
- No diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period
- An autonomous eye exam in the measurement period
- A retinal exam finding with a retinopathy severity level in any part of the measurement period
- A retinal exam finding with no retinopathy severity level in the year prior to the measurement period

Numerator Exclusions

None

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Population Criteria
Definitions
Functions
Terminology
Data Criteria (QDM Data Elements)
Supplemental Data Elements
Risk Adjustment Variables

Population Criteria

Initial Population

  AgeInYearsAt(date from 
    end of "Measurement Period"
  ) in Interval[18, 75]
    and exists ( "Qualifying Encounters" )
    and exists ( ["Diagnosis": "Diabetes"] DiabetesDx
        where DiabetesDx.prevalencePeriod overlaps day of "Measurement Period"
    )

- Denominator
  - "Initial Population"

Denominator Exclusions

  Hospice."Has Hospice Services"
    or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"
    or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
    or PalliativeCare."Has Palliative Care in the Measurement Period"
    or "Bilateral Absence of Eyes"

Numerator

  ( "Diabetic Retinopathy Overlapping Measurement Period"
      and ( "Retinal Exam in Measurement Period" )
  )
    or ( not ( "Diabetic Retinopathy Overlapping Measurement Period" )
        and ( "Retinal Exam in Measurement Period or Year Prior" )
    )
    or "Autonomous Eye Exam in Measurement Period"
    or "Retinal Exam Finding with Retinopathy Severity Level in Measurement Period"
    or "Retinal Exam Finding with No Retinopathy Severity Level in Year Prior"

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Definitions

AIFrailLTCF.Has Advanced Illness in Year Before or During Measurement Period

  exists ( ["Diagnosis": "Advanced Illness"] AdvancedIllnessDiagnosis
      where AdvancedIllnessDiagnosis.prevalencePeriod starts during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"]
  )

AIFrailLTCF.Has Criteria Indicating Frailty

  exists ( ["Device, Order": "Frailty Device"] FrailtyDeviceOrder
      where FrailtyDeviceOrder.authorDatetime during day of "Measurement Period"
  )
    or exists ( ["Assessment, Performed": "Medical equipment used"] EquipmentUsed
        where EquipmentUsed.result in "Frailty Device"
          and Global."NormalizeInterval" ( EquipmentUsed.relevantDatetime, EquipmentUsed.relevantPeriod ) ends during day of "Measurement Period"
    )
    or exists ( ["Diagnosis": "Frailty Diagnosis"] FrailtyDiagnosis
        where FrailtyDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
        where FrailtyEncounter.relevantPeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom
        where FrailtySymptom.prevalencePeriod overlaps day of "Measurement Period"
    )

AIFrailLTCF.Has Dementia Medications in Year Before or During Measurement Period

  exists (["Medication, Active": "Dementia Medications"] DementiaMedication
    where Global."NormalizeInterval" ( DementiaMedication.relevantDatetime, DementiaMedication.relevantPeriod ) overlaps day of Interval[start of "Measurement Period" - 1 year, 
    end of "Measurement Period"])

AIFrailLTCF.Is Age 66 or Older Living Long Term in a Nursing Home

  ( AgeInYearsAt(date from 
      end of "Measurement Period"
    )>= 66
  )
    and ( ( Last(["Assessment, Performed": "Housing status"] HousingStatus
          where Global."NormalizeInterval"(HousingStatus.relevantDatetime, HousingStatus.relevantPeriod) ends on or before day of 
          end of "Measurement Period"
          sort by 
          end of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)asc
      )) LastHousingStatus
        where LastHousingStatus.result ~ "Lives in nursing home (finding)"
    ) is not null

AIFrailLTCF.Is Age 66 or Older with Advanced Illness and Frailty

  ( AgeInYearsAt(date from 
      end of "Measurement Period"
    ) >= 66
      and "Has Criteria Indicating Frailty"
      and ( "Has Advanced Illness in Year Before or During Measurement Period"
          or "Has Dementia Medications in Year Before or During Measurement Period"
      )
  )

Autonomous Eye Exam in Measurement Period

  exists ["Physical Exam, Performed": "Eye Diabetic retinopathy screening Autonomous artificial intelligence"] AutonomousEyeExam
    where AutonomousEyeExam.result in "Autonomous Eye Exam Result or Finding"
        and Global."NormalizeInterval" ( AutonomousEyeExam.relevantDatetime, AutonomousEyeExam.relevantPeriod ) during day of "Measurement Period"

Bilateral Absence of Eyes

    exists (["Diagnosis": "Anophthalmos of bilateral eyes (disorder)"] BilateralAbsenceEyes 
        where BilateralAbsenceEyes.prevalencePeriod starts on or before day of end of "Measurement Period"
    )

Denominator
- - "Initial Population"

Denominator Exclusions

  Hospice."Has Hospice Services"
    or AIFrailLTCF."Is Age 66 or Older with Advanced Illness and Frailty"
    or AIFrailLTCF."Is Age 66 or Older Living Long Term in a Nursing Home"
    or PalliativeCare."Has Palliative Care in the Measurement Period"
    or "Bilateral Absence of Eyes"

Diabetic Retinopathy Overlapping Measurement Period

  exists ( ["Diagnosis": "Diabetic Retinopathy"] Retinopathy
      where Retinopathy.prevalencePeriod overlaps day of "Measurement Period"
  )

Has Left Eye No Retinopathy in Year Prior

  exists (["Physical Exam, Performed": "Left eye Diabetic retinopathy severity level by Ophthalmoscopy"] LeftEyeNoRetinopathy
      where LeftEyeNoRetinopathy.result ~ "No apparent retinopathy"
        and Global."NormalizeInterval" ( LeftEyeNoRetinopathy.relevantDatetime, LeftEyeNoRetinopathy.relevantPeriod ) during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period" - 1 year])

Has Left Eye Retinopathy

  exists ["Physical Exam, Performed": "Left eye Diabetic retinopathy severity level by Ophthalmoscopy"] LeftEyeRetinopathy
    where LeftEyeRetinopathy.result in "Diabetic Retinopathy Severity Level" 
        and Global."NormalizeInterval" ( LeftEyeRetinopathy.relevantDatetime, LeftEyeRetinopathy.relevantPeriod ) during day of "Measurement Period"

Has Right Eye No Retinopathy in Year Prior

  exists (["Physical Exam, Performed": "Right eye Diabetic retinopathy severity level by Ophthalmoscopy"] RightEyeNoRetinopathy
    where RightEyeNoRetinopathy.result ~ "No apparent retinopathy"
        and Global."NormalizeInterval" ( RightEyeNoRetinopathy.relevantDatetime, RightEyeNoRetinopathy.relevantPeriod ) during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period" - 1 year])

Has Right Eye Retinopathy

  exists ["Physical Exam, Performed": "Right eye Diabetic retinopathy severity level by Ophthalmoscopy"] RightEyeRetinopathy
    where RightEyeRetinopathy.result in "Diabetic Retinopathy Severity Level" 
        and Global."NormalizeInterval" ( RightEyeRetinopathy.relevantDatetime, RightEyeRetinopathy.relevantPeriod ) during day of "Measurement Period"

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 
    end of "Measurement Period"
  ) in Interval[18, 75]
    and exists ( "Qualifying Encounters" )
    and exists ( ["Diagnosis": "Diabetes"] DiabetesDx
        where DiabetesDx.prevalencePeriod overlaps day of "Measurement Period"
    )

Numerator

  ( "Diabetic Retinopathy Overlapping Measurement Period"
      and ( "Retinal Exam in Measurement Period" )
  )
    or ( not ( "Diabetic Retinopathy Overlapping Measurement Period" )
        and ( "Retinal Exam in Measurement Period or Year Prior" )
    )
    or "Autonomous Eye Exam in Measurement Period"
    or "Retinal Exam Finding with Retinopathy Severity Level in Measurement Period"
    or "Retinal Exam Finding with No Retinopathy Severity Level in Year Prior"

PalliativeCare.Has Palliative Care in the Measurement Period

  exists ( ["Assessment, Performed": "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"] PalliativeAssessment
      where Global."NormalizeInterval" ( PalliativeAssessment.relevantDatetime, PalliativeAssessment.relevantPeriod ) overlaps day of "Measurement Period"
  )
    or exists ( ["Diagnosis": "Palliative Care Diagnosis"] PalliativeDiagnosis
        where PalliativeDiagnosis.prevalencePeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Encounter, Performed": "Palliative Care Encounter"] PalliativeEncounter
        where PalliativeEncounter.relevantPeriod overlaps day of "Measurement Period"
    )
    or exists ( ["Intervention, Performed": "Palliative Care Intervention"] PalliativeIntervention
        where Global."NormalizeInterval" ( PalliativeIntervention.relevantDatetime, PalliativeIntervention.relevantPeriod ) overlaps day of "Measurement Period"
    )

Qualifying Encounters

  ( ["Encounter, Performed": "Office Visit"]
    union ["Encounter, Performed": "Annual Wellness Visit"]
    union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"]
    union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]
    union ["Encounter, Performed": "Home Healthcare Services"]
    union ["Encounter, Performed": "Ophthalmological Services"]
    union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounters
    where ValidEncounters.relevantPeriod during day of "Measurement Period"

Retinal Exam Finding with No Retinopathy Severity Level in Year Prior

    ( "Has Left Eye No Retinopathy in Year Prior" and "Has Right Eye No Retinopathy in Year Prior" )

Retinal Exam Finding with Retinopathy Severity Level in Measurement Period

    ( "Has Left Eye Retinopathy" and "Has Right Eye Retinopathy" )
        or ("Has Left Eye Retinopathy" and "Has Right Eye No Retinopathy in Year Prior")
        or ("Has Right Eye Retinopathy" and "Has Left Eye No Retinopathy in Year Prior")

Retinal Exam in Measurement Period

  exists ["Physical Exam, Performed": "Retinal or Dilated Eye Exam"] RetinalExam
    where Global."NormalizeInterval" ( RetinalExam.relevantDatetime, RetinalExam.relevantPeriod ) during day of "Measurement Period"

Retinal Exam in Measurement Period or Year Prior

  exists ["Physical Exam, Performed": "Retinal or Dilated Eye Exam"] RetinalExam
    where Global."NormalizeInterval" ( RetinalExam.relevantDatetime, RetinalExam.relevantPeriod ) during day of Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"]

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

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 "Anophthalmos of bilateral eyes (disorder)" ("SNOMEDCT Code (15665641000119103)")
code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
code "Eye Diabetic retinopathy screening Autonomous artificial intelligence" ("LOINC Code (105914-6)")
code "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)" ("LOINC Code (71007-9)")
code "Hospice care [Minimum Data Set]" ("LOINC Code (45755-6)")
code "Housing status" ("LOINC Code (71802-3)")
code "Left eye Diabetic retinopathy severity level by Ophthalmoscopy" ("LOINC Code (71490-7)")
code "Lives in nursing home (finding)" ("SNOMEDCT Code (160734000)")
code "Medical equipment used" ("LOINC Code (98181-1)")
code "No apparent retinopathy" ("LOINC Code (LA18643-9)")
code "Right eye Diabetic retinopathy severity level by Ophthalmoscopy" ("LOINC Code (71491-5)")
code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
valueset "Advanced Illness" (2.16.840.1.113883.3.464.1003.110.12.1082)
valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
valueset "Autonomous Eye Exam Result or Finding" (2.16.840.1.113883.3.464.1004.2616)
valueset "Dementia Medications" (2.16.840.1.113883.3.464.1003.196.12.1510)
valueset "Diabetes" (2.16.840.1.113883.3.464.1003.103.12.1001)
valueset "Diabetic Retinopathy" (2.16.840.1.113883.3.526.3.327)
valueset "Diabetic Retinopathy Severity Level" (2.16.840.1.113883.3.464.1003.1266)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Federal Administrative Sex" (2.16.840.1.113762.1.4.1021.121)
valueset "Frailty Device" (2.16.840.1.113883.3.464.1003.118.12.1300)
valueset "Frailty Diagnosis" (2.16.840.1.113883.3.464.1003.113.12.1074)
valueset "Frailty Encounter" (2.16.840.1.113883.3.464.1003.101.12.1088)
valueset "Frailty Symptom" (2.16.840.1.113883.3.464.1003.113.12.1075)
valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
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 "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
valueset "Ophthalmological Services" (2.16.840.1.113883.3.526.3.1285)
valueset "Palliative Care Diagnosis" (2.16.840.1.113883.3.464.1003.1167)
valueset "Palliative Care Encounter" (2.16.840.1.113883.3.464.1003.101.12.1090)
valueset "Palliative Care Intervention" (2.16.840.1.113883.3.464.1003.198.12.1135)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Preventive Care Services Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
valueset "Preventive Care Services Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Retinal or Dilated Eye Exam" (2.16.840.1.113883.3.464.1003.115.12.1088)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)

Data Criteria (QDM Data Elements)

"Assessment, Performed: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)" using "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) (LOINC Code 71007-9)"
"Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
"Assessment, Performed: Housing status" using "Housing status (LOINC Code 71802-3)"
"Assessment, Performed: Medical equipment used" using "Medical equipment used (LOINC Code 98181-1)"
"Device, Order: Frailty Device" using "Frailty Device (2.16.840.1.113883.3.464.1003.118.12.1300)"
"Diagnosis: Advanced Illness" using "Advanced Illness (2.16.840.1.113883.3.464.1003.110.12.1082)"
"Diagnosis: Anophthalmos of bilateral eyes (disorder)" using "Anophthalmos of bilateral eyes (disorder) (SNOMEDCT Code 15665641000119103)"
"Diagnosis: Diabetes" using "Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001)"
"Diagnosis: Diabetic Retinopathy" using "Diabetic Retinopathy (2.16.840.1.113883.3.526.3.327)"
"Diagnosis: Frailty Diagnosis" using "Frailty Diagnosis (2.16.840.1.113883.3.464.1003.113.12.1074)"
"Diagnosis: Hospice Diagnosis" using "Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165)"
"Diagnosis: Palliative Care Diagnosis" using "Palliative Care Diagnosis (2.16.840.1.113883.3.464.1003.1167)"
"Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Encounter, Performed: Frailty Encounter" using "Frailty Encounter (2.16.840.1.113883.3.464.1003.101.12.1088)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Hospice Encounter" using "Hospice Encounter (2.16.840.1.113883.3.464.1003.1003)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Ophthalmological Services" using "Ophthalmological Services (2.16.840.1.113883.3.526.3.1285)"
"Encounter, Performed: Palliative Care Encounter" using "Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090)"
"Encounter, Performed: Preventive Care Services Established Office Visit, 18 and Up" using "Preventive Care Services Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
"Encounter, Performed: Preventive Care Services Initial Office Visit, 18 and Up" using "Preventive Care Services Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
"Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
"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)"
"Intervention, Performed: Palliative Care Intervention" using "Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135)"
"Medication, Active: Dementia Medications" using "Dementia Medications (2.16.840.1.113883.3.464.1003.196.12.1510)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (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: Federal Administrative Sex" using "Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121)"
"Physical Exam, Performed: Eye Diabetic retinopathy screening Autonomous artificial intelligence" using "Eye Diabetic retinopathy screening Autonomous artificial intelligence (LOINC Code 105914-6)"
"Physical Exam, Performed: Left eye Diabetic retinopathy severity level by Ophthalmoscopy" using "Left eye Diabetic retinopathy severity level by Ophthalmoscopy (LOINC Code 71490-7)"
"Physical Exam, Performed: Retinal or Dilated Eye Exam" using "Retinal or Dilated Eye Exam (2.16.840.1.113883.3.464.1003.115.12.1088)"
"Physical Exam, Performed: Right eye Diabetic retinopathy severity level by Ophthalmoscopy" using "Right eye Diabetic retinopathy severity level by Ophthalmoscopy (LOINC Code 71491-5)"
"Symptom: Frailty Symptom" using "Frailty Symptom (2.16.840.1.113883.3.464.1003.113.12.1075)"

Supplemental Data Elements

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

  ["Patient Characteristic Payer": "Payer Type"]

SDE Race

  ["Patient Characteristic Race": "Race"]

SDE Sex

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

Risk Adjustment Variables

None

Measure Set

None