| eCQM Title | Diabetes: Eye Exam |
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|---|---|---|---|
| eCQM Identifier (Measure Authoring Tool) | 131 | eCQM Version Number | 12.0.000 |
| NQF Number | Not Applicable | GUID | d90bdab4-b9d2-4329-9993-5c34e2c0dc66 |
| Measurement Period | January 1, 20XX through December 31, 20XX | ||
| 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 |
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| Copyright |
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 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 can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2022 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 2022. American Medical Association. All rights reserved. CPT is a trademark of the American Medical Association. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. LOINC(R) copyright 2004-2022 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2022 International Health Terminology Standards Development Organisation. ICD-10 copyright 2022 World Health Organization. All Rights Reserved. |
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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]. |
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| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification |
None |
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| Risk Adjustment |
None |
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| Rate Aggregation |
None |
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| Rationale |
Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3 percent of the U.S. population) and killed more than 87,000 people (American Diabetes Association [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (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 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. It is the leading cause of blindness in adults between 20-74 years of age. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020). |
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| Clinical Recommendation Statement |
American Diabetes Association (2022b): - 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 exam 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) |
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| Improvement Notation |
Higher score indicates better quality |
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| Reference |
Reference Type: CITATION Reference Text: 'American Diabetes Association. (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007' |
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| Reference |
Reference Type: CITATION Reference Text: 'American Diabetes Association. (2022a). Statistics About Diabetes. Retrieved from https://diabetes.org/about-us/statistics/about-diabetes' |
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| Reference |
Reference Type: CITATION Reference Text: 'American Diabetes Association. (2022b). 12. Retinopathy, neuropathy, and foot care: Standards of Medical Care in Diabetes–2022. Diabetes Care 2022; 45(Suppl. 1):S185–S194. https://doi.org/10.2337/dc22-S012' |
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| 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' |
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| 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' |
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| 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' |
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| Definition |
None |
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| Guidance |
The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. 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. |
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| Transmission Format |
TBD |
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| Initial Population |
Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period |
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| Denominator |
Equals Initial Population |
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| 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 who are living long term in a nursing home any time on or before the end 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 with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period. |
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| Numerator |
Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: - Diabetic with 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 - Diabetic with 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 |
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| Numerator Exclusions |
Not Applicable |
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| Denominator Exceptions |
None |
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| Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
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AgeInYearsAt(date from
end of "Measurement Period"
)in Interval[18, 75]
and exists ( "Qualifying Encounters" )
and exists ( ["Diagnosis": "Diabetes"] Diabetes
where Diabetes.prevalencePeriod overlaps "Measurement Period"
)
"Initial Population"
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"
( "Diabetic Retinopathy Overlapping Measurement Period"
and exists ( "Retinal Exam in Measurement Period" )
)
or ( not ( "Diabetic Retinopathy Overlapping Measurement Period" )
and exists ( "Retinal Exam in Measurement Period or Year Prior" )
)
None
None
None
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 "Measurement Period"
)
or exists ( ["Encounter, Performed": "Frailty Encounter"] FrailtyEncounter
where FrailtyEncounter.relevantPeriod overlaps "Measurement Period"
)
or exists ( ["Symptom": "Frailty Symptom"] FrailtySymptom
where FrailtySymptom.prevalencePeriod overlaps "Measurement Period"
)
exists (["Medication, Active": "Dementia Medications"] DementiaMedication where Global."NormalizeInterval" ( DementiaMedication.relevantDatetime, DementiaMedication.relevantPeriod ) overlaps Interval[start of "Measurement Period" - 1 year, end of "Measurement Period"])
exists( ["Encounter, Performed": "Acute Inpatient"] InpatientEncounter
where exists ( InpatientEncounter.diagnoses Diagnosis
where Diagnosis.code in "Advanced Illness"
)
and InpatientEncounter.relevantPeriod starts during day of Interval[start of "Measurement Period" - 1 year,
end of "Measurement Period"])
exists ( from "Outpatient Encounters with Advanced Illness" OutpatientEncounter1, "Outpatient Encounters with Advanced Illness" OutpatientEncounter2 where OutpatientEncounter2.relevantPeriod ends 1 day or more after day of end of OutpatientEncounter1.relevantPeriod return OutpatientEncounter1 )
( 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
end of "Measurement Period"
sort by
end of Global."NormalizeInterval"(relevantDatetime, relevantPeriod)asc
)) LastHousingStatus
where LastHousingStatus.result ~ "Lives in a nursing home (finding)"
) is not null
( AgeInYearsAt(date from
end of "Measurement Period"
)>= 66
and "Has Criteria Indicating Frailty"
and ( "Has Two Outpatient Encounters with Advanced Illness on Different Dates of Service"
or "Has Inpatient Encounter with Advanced Illness"
or "Has Dementia Medications in Year Before or During Measurement Period"
)
)
( ["Encounter, Performed": "Outpatient"]
union ["Encounter, Performed": "Observation"]
union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]
union ["Encounter, Performed": "Nonacute Inpatient"] ) OutpatientEncounter
where exists ( OutpatientEncounter.diagnoses Diagnosis
where Diagnosis.code in "Advanced Illness"
)
and OutpatientEncounter.relevantPeriod starts during day of Interval[start of "Measurement Period" - 1 year,
end of "Measurement Period"]
"Initial Population"
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"
exists ( ["Diagnosis": "Diabetic Retinopathy"] Retinopathy
where Retinopathy.prevalencePeriod overlaps "Measurement Period"
)
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"
)
AgeInYearsAt(date from
end of "Measurement Period"
)in Interval[18, 75]
and exists ( "Qualifying Encounters" )
and exists ( ["Diagnosis": "Diabetes"] Diabetes
where Diabetes.prevalencePeriod overlaps "Measurement Period"
)
( "Diabetic Retinopathy Overlapping Measurement Period"
and exists ( "Retinal Exam in Measurement Period" )
)
or ( not ( "Diabetic Retinopathy Overlapping Measurement Period" )
and exists ( "Retinal Exam in Measurement Period or Year Prior" )
)
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"
)
( ["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"
["Physical Exam, Performed": "Retinal or Dilated Eye Exam"] RetinalExam where Global."NormalizeInterval" ( RetinalExam.relevantDatetime, RetinalExam.relevantPeriod ) during day of "Measurement Period"
["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"]
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
if pointInTime is not null then Interval[pointInTime, pointInTime] else if period is not null then period else null as Interval<DateTime>
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
| Measure Set |
None |
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|---|---|---|---|