Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months
American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
National Committee for Quality Assurance
American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
National Quality Forum
Finalized Date/Time
Copyright 2013 National Committee for Quality Assurance (NCQA) and American Medical Association. All Rights Reserved.
None
None
None
Changes in the optic nerve are one of two characteristics which currently define progression and thus worsening of glaucoma disease status (the other characteristic is visual field). There is a significant gap in documentation patterns of the optic nerve for both initial and follow-up care (Fremont, 2003), even among specialists (Lee, 2006). Examination of the optic nerve head and retinal nerve fiber layer provides valuable structural information about glaucomatous optic nerve damage. Visible structural alterations of the optic nerve head or retinal nerve fiber layer and development of peripapillary choroidal atrophy frequently occur before visual field defects can be detected. Careful study of the optic disc neural rim for small hemorrhages is important, since these hemorrhages can precede visual field loss and further optic nerve damage.
Ophthalmic Evaluation
In completing the elements in the comprehensive adult medical eye evaluation, the ophthalmic evaluation specifically focuses on the following elements:
History [A:III]
Visual acuity measurement [A:III]
Pupil examination [B:II]
Anterior segment examination [A:III]
Intraocular pressure measurement [A:I]
Gonioscopy [A:III]
Optic nerve head and retinal nerve fiber layer examination [A:III]
Fundus examination [A:III)
(AAO, 2010)
Higher score indicates better quality
NQF ID Number
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) (PCPI[R]) 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, eg, 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, PCPI, NCQA nor its members shall be responsible for any use of the Measures.
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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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eMeasure Identifier
143
measureStartDate
measureEndDate
American Academy of Ophthalmology. Preferred Practice Pattern: Primary Open-Angle Glaucoma. 2010.
Fremont AM, et al. Patterns of Care for Open-angle Glaucoma in Managed Care. Arch Ophthalmol. 2003;121:777-783.
Lee PP, et al. A Multicenter, Retrospective Pilot Study of Resource Use and Costs Associated With Severity of Disease in Glaucoma. Arch Ophthalmol. 2006;124:12-19.
None
Optic nerve head evaluation includes examination of the cup to disc ratio and identification of optic disc or retinal nerve abnormalities. Both of these components of the optic nerve head evaluation are examined using ophthalmoscopy.
The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.
Transmission Format
TBD
Initial Patient Population
All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma
Denominator
Equals Initial Patient Population
Denominator Exclusions
None
Numerator
Patients who have an optic nerve head evaluation during one or more office visits within 12 months
Numerator Exclusions
Not Applicable
Denominator Exceptions
Documentation of medical reason(s) for not performing an optic nerve head evaluation
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:
- OR:
- AND: "Occurrence A of Encounter, Performed: Ophthalmological Services" during "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" starts before or during "Occurrence A of Encounter, Performed: Ophthalmological Services"
- AND NOT: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" ends before start of "Occurrence A of Encounter, Performed: Ophthalmological Services"
- OR:
- AND: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility" during "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" starts before or during "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
- AND NOT: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" ends before start of "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
- OR:
- AND: "Occurrence A of Encounter, Performed: Nursing Facility Visit" during "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" starts before or during "Occurrence A of Encounter, Performed: Nursing Facility Visit"
- AND NOT: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" ends before start of "Occurrence A of Encounter, Performed: Nursing Facility Visit"
- OR:
- AND: "Occurrence A of Encounter, Performed: Office Visit" during "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" starts before or during "Occurrence A of Encounter, Performed: Office Visit"
- AND NOT: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" ends before start of "Occurrence A of Encounter, Performed: Office Visit"
- OR:
- AND: "Occurrence A of Encounter, Performed: Outpatient Consultation" during "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" starts before or during "Occurrence A of Encounter, Performed: Outpatient Consultation"
- AND NOT: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" ends before start of "Occurrence A of Encounter, Performed: Outpatient Consultation"
- OR:
- AND: "Occurrence A of Encounter, Performed: Face-to-Face Interaction" during "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" starts before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
- AND NOT: "Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma" ends before start of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
-
Denominator =
- AND: "Initial Patient Population"
-
Denominator Exclusions =
- None
-
Numerator =
- AND:
- AND: "Diagnostic Study, Result: Cup to Disc Ratio (result)"
- AND: "Diagnostic Study, Result: Optic Disc Exam for Structural Abnormalities (result)"
- during
- OR: "Occurrence A of Encounter, Performed: Ophthalmological Services"
- OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
- OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
- OR: "Occurrence A of Encounter, Performed: Office Visit"
- OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
- OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
-
Denominator Exceptions =
- AND:
- OR: "Diagnostic Study, Result not done: Medical Reason" for "Cup to Disc Ratio"
- OR: "Diagnostic Study, Result not done: Medical Reason" for "Optic Disc Exam for Structural Abnormalities"
- starts during
- OR: "Occurrence A of Encounter, Performed: Ophthalmological Services"
- OR: "Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility"
- OR: "Occurrence A of Encounter, Performed: Nursing Facility Visit"
- OR: "Occurrence A of Encounter, Performed: Office Visit"
- OR: "Occurrence A of Encounter, Performed: Outpatient Consultation"
- OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
Patient Characteristic Birthdate: birth date
Measurement Period
Occurrence A of Encounter, Performed: Ophthalmological Services
Measurement Period
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Ophthalmological Services
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Ophthalmological Services
Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility
Measurement Period
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility
Occurrence A of Encounter, Performed: Nursing Facility Visit
Measurement Period
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Nursing Facility Visit
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Nursing Facility Visit
Occurrence A of Encounter, Performed: Office Visit
Measurement Period
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Office Visit
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Office Visit
Occurrence A of Encounter, Performed: Outpatient Consultation
Measurement Period
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Outpatient Consultation
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Outpatient Consultation
Occurrence A of Encounter, Performed: Face-to-Face Interaction
Measurement Period
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Face-to-Face Interaction
Occurrence A of Diagnosis, Active: Primary Open-Angle Glaucoma
Occurrence A of Encounter, Performed: Face-to-Face Interaction
Initial Patient Population
Denominator
Diagnostic Study, Result not done: Medical Reason
Diagnostic Study, Result not done: Medical Reason
Occurrence A of Encounter, Performed: Ophthalmological Services
Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility
Occurrence A of Encounter, Performed: Nursing Facility Visit
Occurrence A of Encounter, Performed: Office Visit
Occurrence A of Encounter, Performed: Outpatient Consultation
Occurrence A of Encounter, Performed: Face-to-Face Interaction
Denominator
Diagnostic Study, Result: Cup to Disc Ratio (result)
Diagnostic Study, Result: Optic Disc Exam for Structural Abnormalities (result)
Occurrence A of Encounter, Performed: Ophthalmological Services
Occurrence A of Encounter, Performed: Care Services in Long-Term Residential Facility
Occurrence A of Encounter, Performed: Nursing Facility Visit
Occurrence A of Encounter, Performed: Office Visit
Occurrence A of Encounter, Performed: Outpatient Consultation
Occurrence A of Encounter, Performed: Face-to-Face Interaction
Data criteria (QDM Data Elements)
-
"Diagnosis, Active: Primary Open-Angle Glaucoma" using "Primary Open-Angle Glaucoma Grouping Value Set (2.16.840.1.113883.3.526.3.326)"
-
"Diagnostic Study, Result not done: Medical Reason" using "Medical Reason Grouping Value Set (2.16.840.1.113883.3.526.3.1007)"
-
"Diagnostic Study, Result not done: Medical Reason" using "Medical Reason Grouping Value Set (2.16.840.1.113883.3.526.3.1007)"
-
"Diagnostic Study, Result: Cup to Disc Ratio" using "Cup to Disc Ratio Grouping Value Set (2.16.840.1.113883.3.526.3.1333)"
-
"Diagnostic Study, Result: Optic Disc Exam for Structural Abnormalities" using "Optic Disc Exam for Structural Abnormalities Grouping Value Set (2.16.840.1.113883.3.526.3.1334)"
-
"Encounter, Performed: Care Services in Long-Term Residential Facility" using "Care Services in Long-Term Residential Facility Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1014)"
-
"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: Nursing Facility Visit" using "Nursing Facility Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1012)"
-
"Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)"
-
"Encounter, Performed: Ophthalmological Services" using "Ophthalmological Services Grouping Value Set (2.16.840.1.113883.3.526.3.1285)"
-
"Encounter, Performed: Outpatient Consultation" using "Outpatient Consultation Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1008)"
-
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
Patient Characteristic Birthdate: birth date
Care Services in Long-Term Residential Facility
Diagnostic Study, Result: Cup to Disc Ratio
Diagnostic Study, Result not done: Medical Reason
Face-to-Face Interaction
Nursing Facility Visit
Office Visit
Ophthalmological Services
Diagnostic Study, Result: Optic Disc Exam for Structural Abnormalities
Diagnostic Study, Result not done: Medical Reason
Outpatient Consultation
Primary Open-Angle Glaucoma
Encounter, Performed: Care Services in Long-Term Residential Facility
Encounter, Performed: Face-to-Face Interaction
Encounter, Performed: Nursing Facility Visit
Encounter, Performed: Office Visit
Encounter, Performed: Ophthalmological Services
Encounter, Performed: Outpatient Consultation
Diagnosis, Active: Primary Open-Angle Glaucoma
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