eMeasure Title Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures
eMeasure Identifier
(Measure Authoring Tool)
132 eMeasure Version number 1
NQF Number 0564 GUID 9a0339c2-3d9b-11e1-8634-00237d5bf174
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Measure Developer American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Measure Developer National Committee for Quality Assurance
Endorsed By National Quality Forum
Description
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.
Copyright
Copyright 2012 American Medical Association and National Committee for Quality Assurance. All Rights Reserved.
Disclaimer
Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (the PCPI [TM]) and the National Committee for Quality Assurance (NCQA).  These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, NCQA, PCPI nor its members shall be responsible for any use of the Measures. 

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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, NCQA, the PCPI and its members 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 2004-2011 American Medical Association. LOINC (R) copyright 2004-2011 Regenstrief Institute, Inc. 
This material contains SNOMED Clinical Terms (R) (SNOMED CT[R]) copyright 2004-2011 International Health Terminology Standards Development Organisation.  ICD-10 Copyright 2011 World Health Organization. All Rights Reserved.

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Measure Scoring Proportion
Measure Type Outcome
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Complications that may result in a permanent loss of vision following cataract surgery are uncommon. This short-term outcomes of surgery indicator seeks to identify those complications from surgery that can reasonably be attributed to the surgery and surgeon and which reflect situations which - if untreated - generally result in significant avoidable vision loss that would negatively impact patient functioning. Further, it seeks to reduce surgeon burden and enhance accuracy in reporting by focusing on those significant complications that can be assessed from administrative data alone and which can be captured by the care of another physician or the provision of additional, separately coded, post-operative services. Finally, it focuses on patient safety and monitoring for events that, while hopefully uncommon, can signify important issues in the care being provided. For example, the need to reposition or exchange an intraocular lens (IOL) reflects in part “wrong power” IOL placement, a major patient safety issue.
In order to achieve these ends, the indicator excludes patients with other known, pre-operative ocular conditions that could impact the likelihood of developing a complication. Based on the results of the Cataract Appropriateness Project at RAND, other published studies, and one analysis performed on a national MCO data base, the exclusion codes would preserve over 2/3 of all cataract surgery cases for analysis. Thus, this provides a “clean” indicator that captures care for the large majority of patients undergoing cataract surgery.
This indicator differs from traditional PQRI measures in that NO self-reporting is required and thus significantly reduces implementation burdens on providers while greatly simplifying the audit complexity for CMS and other payors. As such, it represents an alternative form of performance improvement measurement that can be potentially used for other areas. Finally, the algorithms to be used for this analysis are already available, through work both by one national MCO and internal quality analyses at several institutions.
Clinical Recommendation Statement
This is an outcome measure. As such, there are no statements in the guideline specific to this measurement topic.
Improvement Notation
Lower score indicates better quality
Reference
Cataract in the adult eye. Preferred practice pattern. In: American Academy of Ophthalmology (AAO). San Francisco (CA): American Academy of Ophthalmology (AAO); 2006. p. 69.
Reference
Desai P, Minassian DC, Reidy A. National cataract surgery survey 1997-8: a report of the results of the clinical outcomes. Br J Ophthalmol 1999 Dec;83(12):1336-40.
Reference
Powe NR, Schein OD, Gieser SC, Tielsch JM, Luthra R, Javitt J, Steinberg EP. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994 Feb;112(2):239-52.
Reference
Russell M, Gaskin B, Russell D, Polkinghorne PJ. Pseudophakic retinal detachment after phacoemulsification cataract surgery: Ten-year retrospective review. J Cataract Refract Surg 2006 Mar;32(3):442-5.
Definition
None
Guidance
The unit of analysis is cataract surgery. If a patient had more than one cataract surgery during the measurement period, each cataract surgery will be evaluated.
Transmission Format
TBD
Initial Patient Population
All patients aged 18 years and older who had cataract surgery and no significant pre-operative ocular conditions impacting the surgical complication rate
Denominator
Equals Initial Patient Population
Denominator Exclusions
Patients with any one of a specified list of comorbid conditions that impact the surgical complication rate
Numerator
Patients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
None