Functional Status Assessment for Complex Chronic Conditions

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. 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.

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].

Measuring functional status for patients with complex chronic illness permits longitudinal assessment - from the patient’s perspective - of the effectiveness of symptom management, as well as health-related quality of life (Flynn 2009, Rothrock 2010).

Flynn KE, Pina IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O’Connor CM, Weinfurt KP. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009; 301:1451-1459.

Rose M, Bjorner JB, Becker J, Fries JF, Ware JE. Evaluation of a preliminary physical function item bank supported expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61:17-33.

Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63(11):1195-204.

Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rohendler JA, Spiro A, Miller D, Selim BJ, Fincke BG. Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans. Health Services Research 2010; 45(2): 376-396.

Initial encounter: The first encounter during the first 185 days of the measurement year. Follow-up encounter: The last encounter that is at least 30 days but no more than 180 after the initial encounter. A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity. The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.

Patients with patient reported functional status assessment results (e.g., VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 Global Health, PROMIS-29) present in the EHR within two weeks before or during the initial encounter and the follow-up encounter during the measurement year.

Table of Contents

Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 65 year(s) starts before start of "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Heart Failure" starts before or during "Measurement Period"
- AND:
  - OR: MOST RECENT:
    - AND: "Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
  - OR: MOST RECENT:
    - AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Office Visit"
  - OR: MOST RECENT:
    - AND: "Occurrence B of Encounter, Performed: Office Visit" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Occurrence B of Encounter, Performed: Office Visit" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
  - OR: MOST RECENT:
    - AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" >= 30 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Occurrence B of Encounter, Performed: Face-to-Face Interaction" <= 180 day(s) starts after end of "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
- AND: FIRST:
  - OR: "Occurrence A of Encounter, Performed: Office Visit" <= 185 day(s) ends after start of "Measurement Period"
  - OR: "Occurrence A of Encounter, Performed: Face-to-Face Interaction" <= 185 day(s) ends after start of "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Heart Failure" ends before start of "Measurement Period"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- AND:
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: Severe Dementia" starts before or during "Measurement Period"
    - AND NOT: "Occurrence A of Diagnosis, Active: Severe Dementia" ends before start of "Measurement Period"
  - OR:
    - AND: "Occurrence A of Diagnosis, Active: All Cancer" starts before or during "Measurement Period"
    - AND NOT: "Occurrence A of Diagnosis, Active: All Cancer" ends before start of "Measurement Period"
Numerator =
- AND:
  - OR:
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence B of Encounter, Performed: Office Visit"
  - OR:
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence B of Encounter, Performed: Face-to-Face Interaction"
  - OR:
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence A of Encounter, Performed: Face-to-Face Interaction"
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence B of Encounter, Performed: Office Visit"
  - OR:
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence A of Encounter, Performed: Office Visit"
    - AND: "Functional Status, Result: Functional Status Assessment for Heart Failure" <= 2 week(s) ends before or during "Occurrence B of Encounter, Performed: Face-to-Face Interaction"
Denominator Exceptions =
- None

"Diagnosis, Active: All Cancer" using "All Cancer Grouping Value Set (2.16.840.1.113883.3.464.1003.108.12.1011)"
"Diagnosis, Active: Heart Failure" using "Heart Failure Grouping Value Set (2.16.840.1.113883.3.526.3.376)"
"Diagnosis, Active: Severe Dementia" using "Severe Dementia Grouping Value Set (2.16.840.1.113883.3.526.3.1025)"
"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: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Functional Status, Result: Functional Status Assessment for Heart Failure" using "Functional Status Assessment for Heart Failure Grouping Value Set (2.16.840.1.113883.3.464.1003.118.12.1031)"
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"

None

"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)"

Measure Set

None

eMeasure Title	Functional Status Assessment for Complex Chronic Conditions
eMeasure Identifier (Measure Authoring Tool)	90	eMeasure Version number	4
NQF Number	Not Applicable	GUID	bb9b8ef7-0354-40e0-bec7-d6891b7df519
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	Centers for Medicare & Medicaid Services
Measure Developer	National Committee for Quality Assurance
Endorsed By	None
Description	Percentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessments
Copyright	Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. 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.
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].
Measure Scoring	Proportion
Measure Type	Process
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Measuring functional status for patients with complex chronic illness permits longitudinal assessment - from the patient’s perspective - of the effectiveness of symptom management, as well as health-related quality of life (Flynn 2009, Rothrock 2010).
Clinical Recommendation Statement	Clinicians should ask patients to report on functional status during at least two points in time while undergoing treatment and working with the clinical team to coordinate care. (Selim 2006)
Improvement Notation	A higher score indicates better quality
Reference	Flynn KE, Pina IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O’Connor CM, Weinfurt KP. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009; 301:1451-1459.
Reference	Rose M, Bjorner JB, Becker J, Fries JF, Ware JE. Evaluation of a preliminary physical function item bank supported expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61:17-33.
Reference	Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63(11):1195-204.
Reference	Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rohendler JA, Spiro A, Miller D, Selim BJ, Fincke BG. Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans. Health Services Research 2010; 45(2): 376-396.
Definition	None
Guidance	Initial encounter: The first encounter during the first 185 days of the measurement year. Follow-up encounter: The last encounter that is at least 30 days but no more than 180 after the initial encounter. A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity. The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.
Transmission Format	TBD
Initial Patient Population	Adults aged 65 years and older who had two outpatient encounters during the measurement year and an active diagnosis of heart failure.
Denominator	Equals Initial Patient Population
Denominator Exclusions	Patients with severe cognitive impairment or patients with an active diagnosis of cancer
Numerator	Patients with patient reported functional status assessment results (e.g., VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 Global Health, PROMIS-29) present in the EHR within two weeks before or during the initial encounter and the follow-up encounter during the measurement year.
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