Preventive Care and Screening: Influenza Immunization 10.2.000

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

Copyright 2020 PCPI(R) Foundation. All Rights Reserved.

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. 

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The PCPI encourages use of the Measure by other health care professionals, where appropriate.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members and former members of the AMA-PCPI disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. 

CPT(R) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) is copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2019 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R].

Influenza vaccination is the most effective protection against influenza virus infection (Centers for Disease Control and Prevention [CDC], 2018). Influenza may lead to serious complications including hospitalization or death (CDC, 2018). Influenza vaccine is recommended for all persons aged >=6 months who do not have contraindications to vaccination. However, data indicate that less than half of all eligible individuals receive an influenza vaccination (CDC, 2015). This measure promotes annual influenza vaccination for all persons aged >= 6 months.

Routine annual influenza vaccination is recommended for all persons aged >= 6 months who do not have contraindications. Optimally, vaccination should occur before onset of influenza activity in the community. Although vaccination by the end of October is recommended, vaccine administered in December or later, even if influenza activity has already begun, is likely to be beneficial in the majority of influenza seasons (CDC/Advisory Committee on Immunization Practices [ACIP], 2019).

Higher score indicates better quality

Centers for Disease Control and Prevention. (2018, October 26). About Flu. Retrieved from
http://www.cdc.gov/flu/about/disease/index.htm

Centers for Disease Control and Prevention. (2015, September 17). Flu vaccination coverage: United States, 2014-15 influenza season. Retrieved from 
http://www.cdc.gov/flu/fluvaxview/coverage-1415estimates.htm

Grohskopf, L.A., Alyanak, E., Broder, K. R., Walter, E.B., Fry, A. M., Jernigan, D. B. (2019).  Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2019-20 Influenza Season.  MMWR Recommendations and Reports; 38(No. RR-3), 1-21. doi: http://dx.doi.org/10.15585/mmwr.rr6803a1

Previous Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)

The timeframe for the visit during the "Encounter, Performed": "Encounter-Influenza" or "Procedure, Performed": "Peritoneal Dialysis" or "Procedure, Performed": "Hemodialysis" in the Population Criteria-Denominator, 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 set 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.

Due to the changing stance of the CDC/ACIP recommendations regarding the live attenuated influenza vaccine (LAIV) for a particular flu season, this measure will not include the administration of this specific formulation of the flu vaccination. Given the variance of the timeframes for the annual update cycles, program implementation, and publication of revised recommendations from the CDC/ACIP, it has been determined that the coding for this measure will specifically exclude this formulation, so as not to inappropriately include this form of the vaccine for flu seasons when CDC/ACIP explicitly advise against it. However, it is recommended that all eligible professionals or eligible clinicians to review the guidelines for each flu season to determine appropriateness of the LAIV and other formulations of the flu vaccine. Should the LAIV be recommended for administration for a particular flu season, eligible professional or clinician may consider one of the following options: 1) satisfy the numerator by reporting either previous receipt or using the CVX 88 for unspecified formulation, 2) report a denominator exception, either as a patient reason (e.g., for patient preference) or a system reason (e.g., the institution only carries LAIV).

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

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

Equals Initial Population and seen for a visit between October 1 and March 31

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

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

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

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

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

Initial Population

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 6
)
  and ( exists "Qualifying Encounter During Measurement Period"
      or exists "Hemodialysis During Measurement Period"
      or exists "Peritoneal Dialysis During Measurement Period"
  )

Denominator

"Initial Population"
  and ( exists "Encounter During Influenza Season"
      or exists "Hemodialysis During Influenza Season"
      or exists "Peritoneal Dialysis During Influenza Season"
  )

Denominator Exclusions
- - None

Numerator

exists "Influenza Vaccination Procedure"
  or exists "Influenza Immunization Administered"
  or exists "Influenza Vaccine Previously Received"

Numerator Exclusions
- - None

Denominator Exceptions

exists "Medical Patient or System Reason for Not Performing Influenza Vaccination"
  or exists "Medical Patient or System Reason for Not Administering Influenza Vaccine"
  or exists "Diagnosis of Allergy to Egg"
  or exists "Egg Substance Allergy"
  or exists "Diagnosis of Allergy to Influenza Vaccine"
  or exists "Diagnosis of Intolerance to Influenza Vaccine"
  or exists "Intolerance of Influenza Vaccination Procedure"
  or exists "Allergy or Intolerance to Influenza Vaccine"

Stratification
- - None

Allergy or Intolerance to Influenza Vaccine

["Allergy/Intolerance": "Influenza Vaccine"] FluVaccineAllergyIntolerance
  where FluVaccineAllergyIntolerance.prevalencePeriod overlaps after "Influenza Season"

Denominator

"Initial Population"
  and ( exists "Encounter During Influenza Season"
      or exists "Hemodialysis During Influenza Season"
      or exists "Peritoneal Dialysis During Influenza Season"
  )

Denominator Exceptions

exists "Medical Patient or System Reason for Not Performing Influenza Vaccination"
  or exists "Medical Patient or System Reason for Not Administering Influenza Vaccine"
  or exists "Diagnosis of Allergy to Egg"
  or exists "Egg Substance Allergy"
  or exists "Diagnosis of Allergy to Influenza Vaccine"
  or exists "Diagnosis of Intolerance to Influenza Vaccine"
  or exists "Intolerance of Influenza Vaccination Procedure"
  or exists "Allergy or Intolerance to Influenza Vaccine"

Diagnosis of Allergy to Egg

["Diagnosis": "Allergy to Eggs"] EggAllergy
  where EggAllergy.prevalencePeriod overlaps after "Influenza Season"

Diagnosis of Allergy to Influenza Vaccine

["Diagnosis": "Allergy to Influenza Vaccine"] FluVaccineAllergyDiagnosis
  where FluVaccineAllergyDiagnosis.prevalencePeriod overlaps after "Influenza Season"

Diagnosis of Intolerance to Influenza Vaccine

["Diagnosis": "Intolerance to Influenza Vaccine"] FluVaccineIntoleranceDiagnosis
  where FluVaccineIntoleranceDiagnosis.prevalencePeriod overlaps after "Influenza Season"

Egg Substance Allergy

["Allergy/Intolerance": "Egg Substance"] AllergyEggSubstance
  where AllergyEggSubstance.prevalencePeriod overlaps after "Influenza Season"

Encounter During Influenza Season

["Encounter, Performed": "Encounter-Influenza"] FluEncounter
  where FluEncounter.relevantPeriod starts during "Influenza Season"

Hemodialysis During Influenza Season

["Procedure, Performed": "Hemodialysis"] FluSeasonHemodialysis
  where FluSeasonHemodialysis.relevantPeriod overlaps "Influenza Season"

Hemodialysis During Measurement Period

["Procedure, Performed": "Hemodialysis"] Hemodialysis
  where Hemodialysis.relevantPeriod overlaps "Measurement Period"

Influenza Immunization Administered

["Immunization, Administered": "Influenza Vaccine"] AdministeredFluVaccine
  where AdministeredFluVaccine.relevantDatetime during "Influenza Season Including August and September of the Prior Year"

Influenza Season

Interval[start of "Measurement Period" - 3 months, start of "Measurement Period" + 3 months )

Influenza Season Including August and September of the Prior Year

Interval[start of "Measurement Period" - 5 months, start of "Measurement Period" + 3 months )

Influenza Vaccination Procedure

["Procedure, Performed": "Influenza Vaccination"] FluVaccination
  where FluVaccination.relevantDatetime during "Influenza Season Including August and September of the Prior Year"

Influenza Vaccine Previously Received

["Assessment, Performed": "Previous Receipt of Influenza Vaccine"] PreviousReceiptFluVaccine
  where PreviousReceiptFluVaccine.relevantDatetime during "Influenza Season Including August and September of the Prior Year"

Initial Population

exists ( ["Patient Characteristic Birthdate": "Birth date"] BirthDate
    where Global."CalendarAgeInMonthsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 6
)
  and ( exists "Qualifying Encounter During Measurement Period"
      or exists "Hemodialysis During Measurement Period"
      or exists "Peritoneal Dialysis During Measurement Period"
  )

Intolerance of Influenza Vaccination Procedure

["Allergy/Intolerance": "Influenza Vaccination"] FluVaccinationIntolerance
  where FluVaccinationIntolerance.prevalencePeriod overlaps after "Influenza Season"

Medical Patient or System Reason for Not Administering Influenza Vaccine

["Immunization, Not Administered": "Influenza Vaccine"] NoFluVaccine
  where NoFluVaccine.authorDatetime during "Influenza Season Including August and September of the Prior Year"
    and ( NoFluVaccine.negationRationale in "Medical Reason"
        or NoFluVaccine.negationRationale in "Patient Reason"
        or NoFluVaccine.negationRationale in "System Reason"
        or NoFluVaccine.negationRationale in "Influenza Vaccination Declined"
    )

Medical Patient or System Reason for Not Performing Influenza Vaccination

["Procedure, Not Performed": "Influenza Vaccination"] NoFluVaccination
  where NoFluVaccination.authorDatetime during "Influenza Season Including August and September of the Prior Year"
    and ( NoFluVaccination.negationRationale in "Medical Reason"
        or NoFluVaccination.negationRationale in "Patient Reason"
        or NoFluVaccination.negationRationale in "System Reason"
        or NoFluVaccination.negationRationale in "Influenza Vaccination Declined"
    )

Numerator

exists "Influenza Vaccination Procedure"
  or exists "Influenza Immunization Administered"
  or exists "Influenza Vaccine Previously Received"

Peritoneal Dialysis During Influenza Season

["Procedure, Performed": "Peritoneal Dialysis"] FluSeasonPeritonealDialysis
  where FluSeasonPeritonealDialysis.relevantPeriod overlaps "Influenza Season"

Peritoneal Dialysis During Measurement Period

["Procedure, Performed": "Peritoneal Dialysis"] PeritonealDialysis
  where PeritonealDialysis.relevantPeriod overlaps "Measurement Period"

Qualifying Encounter During Measurement Period

( ["Encounter, Performed": "Office Visit"]
  union ["Encounter, Performed": "Outpatient Consultation"]
  union ["Encounter, Performed": "Care Services in Long-Term Residential Facility"]
  union ["Encounter, Performed": "Home Healthcare Services"]
  union ["Encounter, Performed": "Patient Provider Interaction"]
  union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services-Initial Office Visit, 18 and Up"]
  union ["Encounter, Performed": "Preventive Care Services-Individual Counseling"]
  union ["Encounter, Performed": "Preventive Care Services - Group Counseling"]
  union ["Encounter, Performed": "Preventive Care Services - Other"]
  union ["Encounter, Performed": "Discharge Services - Nursing Facility"]
  union ["Encounter, Performed": "Nursing Facility Visit"]
  union ["Encounter, Performed": "Annual Wellness Visit"]
  union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services - Established Office Visit, 18 and Up"] ) QualifyingEncounter
  where QualifyingEncounter.relevantPeriod during "Measurement Period"

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

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

Global.CalendarAgeInMonthsAt(BirthDateTime DateTime, AsOf DateTime)
- - months between ToDate(BirthDateTime)and ToDate(AsOf)

Global.ToDate(Value DateTime)

DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)

Terminology

code "Birth date" ("LOINC Code (21112-8)")
valueset "Allergy to Eggs" (2.16.840.1.113883.3.526.3.1253)
valueset "Allergy to Influenza Vaccine" (2.16.840.1.113883.3.526.3.1256)
valueset "Annual Wellness Visit" (2.16.840.1.113883.3.526.3.1240)
valueset "Care Services in Long-Term Residential Facility" (2.16.840.1.113883.3.464.1003.101.12.1014)
valueset "Discharge Services - Nursing Facility" (2.16.840.1.113883.3.464.1003.101.12.1013)
valueset "Egg Substance" (2.16.840.1.113883.3.526.3.1537)
valueset "Encounter-Influenza" (2.16.840.1.113883.3.526.3.1252)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Hemodialysis" (2.16.840.1.113883.3.526.3.1083)
valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
valueset "Influenza Vaccination" (2.16.840.1.113883.3.526.3.402)
valueset "Influenza Vaccination Declined" (2.16.840.1.113883.3.526.3.1255)
valueset "Influenza Vaccine" (2.16.840.1.113883.3.526.3.1254)
valueset "Intolerance to Influenza Vaccine" (2.16.840.1.113883.3.526.3.1257)
valueset "Medical Reason" (2.16.840.1.113883.3.526.3.1007)
valueset "Nursing Facility Visit" (2.16.840.1.113883.3.464.1003.101.12.1012)
valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
valueset "Outpatient Consultation" (2.16.840.1.113883.3.464.1003.101.12.1008)
valueset "Patient Provider Interaction" (2.16.840.1.113883.3.526.3.1012)
valueset "Patient Reason" (2.16.840.1.113883.3.526.3.1008)
valueset "Payer" (2.16.840.1.114222.4.11.3591)
valueset "Peritoneal Dialysis" (2.16.840.1.113883.3.526.3.1084)
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 - Group Counseling" (2.16.840.1.113883.3.464.1003.101.12.1027)
valueset "Preventive Care Services - Other" (2.16.840.1.113883.3.464.1003.101.12.1030)
valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
valueset "Preventive Care Services-Individual Counseling" (2.16.840.1.113883.3.464.1003.101.12.1026)
valueset "Preventive Care Services-Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Previous Receipt of Influenza Vaccine" (2.16.840.1.113883.3.526.3.1185)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "System Reason" (2.16.840.1.113883.3.526.3.1009)

Data Criteria (QDM Data Elements)

"Allergy/Intolerance: Egg Substance" using "Egg Substance (2.16.840.1.113883.3.526.3.1537)"
"Allergy/Intolerance: Influenza Vaccination" using "Influenza Vaccination (2.16.840.1.113883.3.526.3.402)"
"Allergy/Intolerance: Influenza Vaccine" using "Influenza Vaccine (2.16.840.1.113883.3.526.3.1254)"
"Assessment, Performed: Previous Receipt of Influenza Vaccine" using "Previous Receipt of Influenza Vaccine (2.16.840.1.113883.3.526.3.1185)"
"Diagnosis: Allergy to Eggs" using "Allergy to Eggs (2.16.840.1.113883.3.526.3.1253)"
"Diagnosis: Allergy to Influenza Vaccine" using "Allergy to Influenza Vaccine (2.16.840.1.113883.3.526.3.1256)"
"Diagnosis: Intolerance to Influenza Vaccine" using "Intolerance to Influenza Vaccine (2.16.840.1.113883.3.526.3.1257)"
"Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240)"
"Encounter, Performed: Care Services in Long-Term Residential Facility" using "Care Services in Long-Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014)"
"Encounter, Performed: Discharge Services - Nursing Facility" using "Discharge Services - Nursing Facility (2.16.840.1.113883.3.464.1003.101.12.1013)"
"Encounter, Performed: Encounter-Influenza" using "Encounter-Influenza (2.16.840.1.113883.3.526.3.1252)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Nursing Facility Visit" using "Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Outpatient Consultation" using "Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008)"
"Encounter, Performed: Patient Provider Interaction" using "Patient Provider Interaction (2.16.840.1.113883.3.526.3.1012)"
"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 - Group Counseling" using "Preventive Care Services - Group Counseling (2.16.840.1.113883.3.464.1003.101.12.1027)"
"Encounter, Performed: Preventive Care Services - Other" using "Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030)"
"Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
"Encounter, Performed: Preventive Care Services-Individual Counseling" using "Preventive Care Services-Individual Counseling (2.16.840.1.113883.3.464.1003.101.12.1026)"
"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: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
"Immunization, Administered: Influenza Vaccine" using "Influenza Vaccine (2.16.840.1.113883.3.526.3.1254)"
"Immunization, Not Administered: Influenza Vaccine" using "Influenza Vaccine (2.16.840.1.113883.3.526.3.1254)"
"Patient Characteristic Birthdate: Birth date" using "Birth date (LOINC Code 21112-8)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer (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: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
"Procedure, Not Performed: Influenza Vaccination" using "Influenza Vaccination (2.16.840.1.113883.3.526.3.402)"
"Procedure, Performed: Hemodialysis" using "Hemodialysis (2.16.840.1.113883.3.526.3.1083)"
"Procedure, Performed: Influenza Vaccination" using "Influenza Vaccination (2.16.840.1.113883.3.526.3.402)"
"Procedure, Performed: Peritoneal Dialysis" using "Peritoneal Dialysis (2.16.840.1.113883.3.526.3.1084)"

Supplemental Data Elements

SDE Ethnicity

["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

["Patient Characteristic Payer": "Payer"]

SDE Race
- - ["Patient Characteristic Race": "Race"]

SDE Sex

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

Risk Adjustment Variables

None

Measure Set

None

Preventive Care and Screening: Influenza Immunization

Table of Contents

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables