Preventive Care and Screening: Influenza Immunization 12.0.000

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

This Physician Performance Measure (Measure) and related data specifications are owned 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. The Physician Consortium for Performance Improvement’s (PCPI) and American Medical Association’s (AMA) significant past efforts and contributions to the development and updating of the measure are acknowledged. (C) 2012-2021 National Committee for Quality Assurance. All Rights Reserved.

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CPT(R) contained in the Measure specifications is copyright 2004-2021 American Medical Association. LOINC(R) copyright 2004-2021 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2021 International Health Terminology Standards Development Organisation. ICD-10 copyright 2021 World Health Organization. All Rights Reserved.

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].

Influenza vaccination is the most effective protection against influenza virus infection (Centers for Disease Control and Prevention [CDC], 2019). Influenza may lead to serious complications including hospitalization or death (CDC, 2019). 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, 2019). 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. For each recipient, a licensed and age-appropriate vaccine should be used. Advisory Committee on Immunization Practices (ACIP) makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. During the 2021–22 influenza season, the following types of vaccines are expected to be available: inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) (CDC/Advisory Committee on Immunization Practices [ACIP], 2021).

Higher score indicates better quality

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2019, September 5). About Flu. Retrieved from
https://www.cdc.gov/flu/about/index.html'

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2019, September 26). Flu Vaccination Coverage: United States, 2018-19 Influenza Season. Retrieved from 
https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm'

Reference Type: CITATION

Reference Text: 'Grohskopf LA, Alyanak E, Ferdinands JM, et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 Influenza Season. MMWR Recomm Rep 2021;70(No. RR-5),1–28. DOI: http://dx.doi.org/10.15585/mmwr.rr7005a1external icon.'

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 July 1st)

To enable reporting of this measure at the close of the measurement period, this measure will only assess the influenza season that starts on October 1 of the year prior to the measurement period and ends on March 31 of the measurement period. The subsequent influenza season (ending March of the following year) will be measured and reported in the following year.

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.

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 of the year prior to the measurement period and March 31 of the measurement period

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

Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization between July 1 of the year prior to the measurement period to June 30 of the measurement period

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

Initial Population

AgeInMonthsAt(date from start of "Measurement Period")>= 6
  and ( exists "Qualifying Encounters 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
  - Hospice."Has Hospice Services"

Numerator

exists "Influenza Vaccination Procedure"
  or exists "Influenza Immunization Administered"

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Between July 1 of the Year Prior to the Measurement Period and June 30 of the Measurement Period
- - Interval[start of "Measurement Period" - 6 months, start of "Measurement Period" + 6 months )

Denominator

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

Denominator Exclusions
- - Hospice."Has Hospice Services"

Encounter During Influenza Season

( ["Encounter, Performed": "Annual Wellness Visit"]
  union ["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": "Preventive Care Services, Initial Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"]
  union ["Encounter, Performed": "Unlisted preventive medicine service"]
  union ["Encounter, Performed": "Preventive Care Services Group Counseling"]
  union ["Encounter, Performed": "Preventive Care Services Individual Counseling"]
  union ["Encounter, Performed": "Discharge Services Nursing Facility"]
  union ["Encounter, Performed": "Nursing Facility Visit"]
  union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
  union ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"] ) FluEncounter
  where FluEncounter.relevantPeriod starts during day of "Influenza Season"

Hemodialysis During Influenza Season

["Procedure, Performed": "Hemodialysis"] FluSeasonHemodialysis
  where Global."NormalizeInterval" ( FluSeasonHemodialysis.relevantDatetime, FluSeasonHemodialysis.relevantPeriod ) overlaps "Influenza Season"

Hemodialysis During Measurement Period

["Procedure, Performed": "Hemodialysis"] Hemodialysis
  where Global."NormalizeInterval" ( Hemodialysis.relevantDatetime, Hemodialysis.relevantPeriod ) overlaps "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 "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 "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 "Measurement Period"
  )

Influenza Immunization Administered

( ["Immunization, Administered": "Influenza Vaccine"]
  union ["Immunization, Administered": "Influenza Virus LAIV Immunization"] ) AdministeredFluVaccine
  where AdministeredFluVaccine.relevantDatetime during day of "Between July 1 of the Year Prior to the Measurement Period and June 30 of the Measurement Period"

Influenza Season

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

Influenza Vaccination Procedure

( ["Procedure, Performed": "Influenza Vaccination"]
  union ["Procedure, Performed": "Influenza Virus LAIV Procedure"] ) FluVaccination
  where Global."NormalizeInterval" ( FluVaccination.relevantDatetime, FluVaccination.relevantPeriod ) during day of "Between July 1 of the Year Prior to the Measurement Period and June 30 of the Measurement Period"

Initial Population

AgeInMonthsAt(date from start of "Measurement Period")>= 6
  and ( exists "Qualifying Encounters During Measurement Period"
      or exists "Hemodialysis During Measurement Period"
      or exists "Peritoneal Dialysis During Measurement Period"
  )

Numerator

exists "Influenza Vaccination Procedure"
  or exists "Influenza Immunization Administered"

Peritoneal Dialysis During Influenza Season

["Procedure, Performed": "Peritoneal Dialysis"] FluSeasonPeritonealDialysis
  where Global."NormalizeInterval" ( FluSeasonPeritonealDialysis.relevantDatetime, FluSeasonPeritonealDialysis.relevantPeriod ) overlaps "Influenza Season"

Peritoneal Dialysis During Measurement Period

["Procedure, Performed": "Peritoneal Dialysis"] PeritonealDialysis
  where Global."NormalizeInterval" ( PeritonealDialysis.relevantDatetime, PeritonealDialysis.relevantPeriod ) overlaps "Measurement Period"

Qualifying Encounters 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": "Unlisted preventive medicine service"]
  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"]
  union ["Encounter, Performed": "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal."]
  union ["Encounter, Performed": "Online Assessments"]
  union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounters
  where ValidEncounters.relevantPeriod during day of "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.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>

code "Discharge to healthcare facility for hospice care (procedure)" ("SNOMEDCT Code (428371000124100)")
code "Discharge to home for hospice care (procedure)" ("SNOMEDCT Code (428361000124107)")
code "Hospice care [Minimum Data Set]" ("LOINC Code (45755-6)")
code "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal." ("CPT Code (99211)")
code "Unlisted preventive medicine service" ("CPT Code (99429)")
code "Yes (qualifier value)" ("SNOMEDCT Code (373066001)")
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 "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
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 "Hospice Care Ambulatory" (2.16.840.1.113883.3.526.3.1584)
valueset "Hospice Encounter" (2.16.840.1.113883.3.464.1003.1003)
valueset "Influenza Vaccination" (2.16.840.1.113883.3.526.3.402)
valueset "Influenza Vaccine" (2.16.840.1.113883.3.526.3.1254)
valueset "Influenza Virus LAIV Immunization" (2.16.840.1.113883.3.464.1003.110.12.1087)
valueset "Influenza Virus LAIV Procedure" (2.16.840.1.113883.3.464.1003.110.12.1088)
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 "Online Assessments" (2.16.840.1.113883.3.464.1003.101.12.1089)
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 "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 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 Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)

"Assessment, Performed: Hospice care [Minimum Data Set]" using "Hospice care [Minimum Data Set] (LOINC Code 45755-6)"
"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 Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"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: Nursing Facility Visit" using "Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012)"
"Encounter, Performed: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal." using "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. (CPT Code 99211)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Online Assessments" using "Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089)"
"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 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 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, 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)"
"Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
"Encounter, Performed: Unlisted preventive medicine service" using "Unlisted preventive medicine service (CPT Code 99429)"
"Immunization, Administered: Influenza Vaccine" using "Influenza Vaccine (2.16.840.1.113883.3.526.3.1254)"
"Immunization, Administered: Influenza Virus LAIV Immunization" using "Influenza Virus LAIV Immunization (2.16.840.1.113883.3.464.1003.110.12.1087)"
"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)"
"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, 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: Influenza Virus LAIV Procedure" using "Influenza Virus LAIV Procedure (2.16.840.1.113883.3.464.1003.110.12.1088)"
"Procedure, Performed: Peritoneal Dialysis" using "Peritoneal Dialysis (2.16.840.1.113883.3.526.3.1084)"

["Patient Characteristic Ethnicity": "Ethnicity"]

["Patient Characteristic Payer": "Payer"]

```
["Patient Characteristic Race": "Race"]
```

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

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