Diabetes: Urine Protein Screening
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period.
National Committee for Quality Assurance
National Committee for Quality Assurance
National Quality Forum
Finalized Date/Time
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CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.
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Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin (National Institute of Diabetes and Digestive and Kidney Diseases 2011). It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death (National Institute of Diabetes and Digestive and Kidney Diseases 2011). Diabetes may cause life-threatening, life-ending or life-altering complications, including end-stage kidney disease. Diabetes is the primary cause of kidney failure, accounting for 44 percent of newly diagnosed cases in 2005 (National Institute of Diabetes and Digestive and Kidney Diseases 2011). Clinical guidelines recommend regular testing to evaluate urine albumin excretions and serum creatinine and the estimated glomerular filtration rate derived from serum creatinine, in addition to comparing measurements when screening for chronic kidney disease (American Diabetes Association 2009; American Association of Clinical Endocrinologists 2007).
American Diabetes Association (2009):
- Perform an annual test to assess urine albumin excretion in type 1 diabetic patients with diabetes duration of >=5 years and in all type 2 diabetic patients, starting at diagnosis. (Level of Evidence E)
- Measure serum creatinine at least annually in all adults with diabetes regardless of the degree of urine albumin excretion. The serum creatinine should be used to estimate GFR and stage the level of chronic kidney disease (CKD), if present. (Level of Evidence E)
- In the treatment of the nonpregnant patient with micro- or macroalbuminuria, either ACE Inhibitors or ARBs should be used. (Level of Evidence A)
American Association of Clinical Endocrinologists (2007): Screen all patients with diabetes mellitus for chronic kidney disease annually; screening should begin 5 years after diagnosis in patients with Type 1 diabetes mellitus (T1DM) and at the time of diagnosis in patients with Type 2 diabetes mellitus (T2DM). Testing includes:
- Measurement of albumin-to-creatinine ratio in a spot urine specimen and measurement of the estimated glomerular filtration rate derived from serum creatinine
- The following are diagnostic criteria for chronic kidney disease:
. Estimated glomerular filtration rate <60 mL/min/1.73 m2 or albumin-to-creatinine ratio >=30 mg albumin/g creatinine
. Microalbuminuria >=30 mg albumin/g creatinine
. Macroalbuminuria >=300 mg albumin/g creatinine (Grade A)
. Prescribe an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in the antihypertensive regimen in the absence of contraindications. (Grade A)
California Healthcare Foundation/American Geriatrics Society (2003): A test for the presence of microalbumin should be performed at diagnosis in patients with type 2 diabetes mellitus. After the initial screening and in the absence of previously demonstrated macro- or microalbuminuria, a test for the presence of microalbumin should be performed annually. (Level III, Grade A)
Higher score indicates better quality
NQF ID Number
Disclaimer
These performance 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 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].
eMeasure Identifier
134
measureStartDate
measureEndDate
American Association of Clinical Endocrinologists. 2007. "Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus." Endocr Pract 13(Suppl 1):4-68.
American Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32 (Suppl 1):S6-S12.
California Healthcare Foundation/American Geriatrics Society Panel on Improving Care of Elders with Diabetes. 2003. "Guidelines for Improving the Care of the Older Person with Diabetes Mellitus." J Am Geriatr Soc 51:S265-S280. http://www.americangeriatrics.org/education/diabetes_executive_summary.shtml
National Institute of Diabetes and Digestive and Kidney Diseases. 2011. "Causes of Diabetes." (September)
http://diabetes.niddk.nih.gov/dm/pubs/causes/index.aspx
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Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.
Transmission Format
TBD
Initial Patient Population
Patients 18-75 years of age with diabetes with a visit during the measurement period
Denominator
Equals Initial Patient Population
Denominator Exclusions
None
Numerator
Patients with a screening for nephropathy or evidence of nephropathy during the measurement period
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.
None
Population criteria
-
Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 18 year(s) starts before start of "Measurement Period"
- AND: "Patient Characteristic Birthdate: birth date" < 75 year(s) starts before start of "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Diabetes" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Diabetes" ends before start of "Measurement Period"
- AND:
- OR: "Encounter, Performed: Office Visit"
- OR: "Encounter, Performed: Face-to-Face Interaction"
- OR: "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up"
- OR: "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up"
- OR: "Encounter, Performed: Home Healthcare Services"
- OR: "Encounter, Performed: Annual Wellness Visit"
- during "Measurement Period"
-
Denominator =
- AND: "Initial Patient Population"
-
Denominator Exclusions =
- None
-
Numerator =
- AND:
- OR:
- AND: "Occurrence A of Medication, Active: ACE Inhibitor or ARB" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Medication, Active: ACE Inhibitor or ARB" ends before start of "Measurement Period"
- OR:
- AND: "Occurrence A of Diagnosis, Active: Hypertensive Chronic Kidney Disease" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Hypertensive Chronic Kidney Disease" ends before start of "Measurement Period"
- OR:
- AND: "Occurrence A of Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome" ends before start of "Measurement Period"
- OR:
- AND: "Occurrence A of Diagnosis, Active: Diabetic Nephropathy" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Diabetic Nephropathy" ends before start of "Measurement Period"
- OR:
- AND: "Occurrence A of Diagnosis, Active: Proteinuria" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Proteinuria" ends before start of "Measurement Period"
- OR:
- OR: "Procedure, Performed: Kidney Transplant"
- OR: "Procedure, Performed: Vascular Access for Dialysis"
- OR: "Procedure, Performed: Dialysis Services"
- OR: "Intervention, Performed: Other Services Related to Dialysis"
- OR: "Intervention, Performed: Dialysis Education"
- OR: "Encounter, Performed: ESRD Monthly Outpatient Services"
- OR: "Laboratory Test, Result: Microalbumin Test (result)"
- OR: "Laboratory Test, Result: Macroalbumin Test (result: 'Positive Finding')"
- during "Measurement Period"
-
Denominator Exceptions =
- None
Patient Characteristic Birthdate: birth date
Measurement Period
Patient Characteristic Birthdate: birth date
Measurement Period
Occurrence A of Diagnosis, Active: Diabetes
Measurement Period
Occurrence A of Diagnosis, Active: Diabetes
Measurement Period
Encounter, Performed: Office Visit
Encounter, Performed: Face-to-Face Interaction
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up
Encounter, Performed: Home Healthcare Services
Encounter, Performed: Annual Wellness Visit
Measurement Period
Initial Patient Population
Denominator
Occurrence A of Medication, Active: ACE Inhibitor or ARB
Measurement Period
Occurrence A of Medication, Active: ACE Inhibitor or ARB
Measurement Period
Occurrence A of Diagnosis, Active: Hypertensive Chronic Kidney Disease
Measurement Period
Occurrence A of Diagnosis, Active: Hypertensive Chronic Kidney Disease
Measurement Period
Occurrence A of Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome
Measurement Period
Occurrence A of Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome
Measurement Period
Occurrence A of Diagnosis, Active: Diabetic Nephropathy
Measurement Period
Occurrence A of Diagnosis, Active: Diabetic Nephropathy
Measurement Period
Occurrence A of Diagnosis, Active: Proteinuria
Measurement Period
Occurrence A of Diagnosis, Active: Proteinuria
Measurement Period
Procedure, Performed: Kidney Transplant
Procedure, Performed: Vascular Access for Dialysis
Procedure, Performed: Dialysis Services
Intervention, Performed: Other Services Related to Dialysis
Intervention, Performed: Dialysis Education
Encounter, Performed: ESRD Monthly Outpatient Services
Laboratory Test, Result: Microalbumin Test (result)
Laboratory Test, Result: Macroalbumin Test (result: 'Positive Finding')
Measurement Period
Data criteria (QDM Data Elements)
-
"Diagnosis, Active: Diabetes" using "Diabetes Grouping Value Set (2.16.840.1.113883.3.464.1003.103.12.1001)"
-
"Diagnosis, Active: Diabetic Nephropathy" using "Diabetic Nephropathy Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1004)"
-
"Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome" using "Glomerulonephritis and Nephrotic Syndrome Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1018)"
-
"Diagnosis, Active: Hypertensive Chronic Kidney Disease" using "Hypertensive Chronic Kidney Disease Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1017)"
-
"Diagnosis, Active: Proteinuria" using "Proteinuria Grouping Value Set (2.16.840.1.113883.3.526.3.1003)"
-
"Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit Grouping Value Set (2.16.840.1.113883.3.526.3.1240)"
-
"Encounter, Performed: ESRD Monthly Outpatient Services" using "ESRD Monthly Outpatient Services Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1014)"
-
"Encounter, Performed: Face-to-Face Interaction" using "Face-to-Face Interaction Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1048)"
-
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1016)"
-
"Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)"
-
"Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up Grouping Value Set (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 Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1023)"
-
"Intervention, Performed: Dialysis Education" using "Dialysis Education Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1016)"
-
"Intervention, Performed: Other Services Related to Dialysis" using "Other Services Related to Dialysis Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1015)"
-
"Laboratory Test, Result: Macroalbumin Test" using "Macroalbumin Test Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1019)"
-
"Laboratory Test, Result: Microalbumin Test" using "Microalbumin Test Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1005)"
-
"Medication, Active: ACE Inhibitor or ARB" using "ACE Inhibitor or ARB Grouping Value Set (2.16.840.1.113883.3.526.3.1139)"
-
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
-
"Procedure, Performed: Dialysis Services" using "Dialysis Services Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1013)"
-
"Procedure, Performed: Kidney Transplant" using "Kidney Transplant Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1012)"
-
"Procedure, Performed: Vascular Access for Dialysis" using "Vascular Access for Dialysis Grouping Value Set (2.16.840.1.113883.3.464.1003.109.12.1011)"
-
Attribute: "Result: Positive Finding" using "Positive Finding Grouping Value Set (2.16.840.1.113883.3.464.1003.121.12.1016)"
ACE Inhibitor or ARB
Encounter, Performed: Annual Wellness Visit
Patient Characteristic Birthdate: birth date
Diabetes
Diabetic Nephropathy
Intervention, Performed: Dialysis Education
Procedure, Performed: Dialysis Services
Encounter, Performed: ESRD Monthly Outpatient Services
Encounter, Performed: Face-to-Face Interaction
Glomerulonephritis and Nephrotic Syndrome
Encounter, Performed: Home Healthcare Services
Hypertensive Chronic Kidney Disease
Procedure, Performed: Kidney Transplant
Laboratory Test, Result: Macroalbumin Test
Laboratory Test, Result: Microalbumin Test
Encounter, Performed: Office Visit
Intervention, Performed: Other Services Related to Dialysis
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up
Proteinuria
Procedure, Performed: Vascular Access for Dialysis
Medication, Active: ACE Inhibitor or ARB
Diagnosis, Active: Diabetes
Diagnosis, Active: Diabetic Nephropathy
Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome
Diagnosis, Active: Hypertensive Chronic Kidney Disease
Diagnosis, Active: Proteinuria
Reporting Stratification
- None
Supplemental Data Elements
-
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
-
"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
-
"Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
-
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"
Patient Characteristic Ethnicity: Ethnicity
Patient Characteristic Sex: ONC Administrative Sex
Patient Characteristic Payer: Payer
Patient Characteristic Race: Race