eMeasure Title

Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL-C Control (<100 mg/dL)

eMeasure Identifier (Measure Authoring Tool) 182 eMeasure Version number 6.0.000
NQF Number Not Applicable GUID 500e4792-7f94-4e34-8546-ee71c56fe463
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward National Committee for Quality Assurance
Measure Developer National Committee for Quality Assurance
Endorsed By None
Description
Percentage of patients 18 years of age and older who were diagnosed with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose most recent Low-density Lipoprotein (LDL-C) was adequately controlled (< 100 mg/dL)
Copyright
Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 

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(C) 2008-2016 National Committee for Quality Assurance. All Rights Reserved. 

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 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT [R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 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
A 10 percent decrease in total cholesterol levels (population wide) may result in an estimated 30 percent reduction in the incidence of coronary heart disease (CHD) (Centers for Disease Control and Prevention 2000). Based on data from the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults:
*Less than half of persons who qualify for any kind of lipid-modifying treatment for CHD risk reduction are receiving it
*Less than half of even the highest-risk persons, those who have symptomatic CHD, are receiving lipid-lowering treatment
*Only about a third of treated patients are achieving their LDL goal; less than 20 percent of CHD patients are at their LDL goal (National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Pressure 2002)

According to data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1991 - 2003, the prevalence of cholesterol screening during the preceding 5 years increased from 67.3 percent in 1991 to 73.1 percent in 2003 (Centers for Disease Control and Prevention 2005).

Between 1988-94 and 1999-2002, the age-adjusted mean total serum cholesterol level of adults 20 years of age and  older decreased from 206 mg/dL to 203 mg/dL, and LDL cholesterol levels decreased from 129 mg/dL to 123 mg/dL. The mean level of LDL cholesterol for American adults age 20 and older is 123 mg/dL (Carroll et al. 2005). However, even given this decrease, there is still a significant amount of room for improvement.
Clinical Recommendation Statement
Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). (2002) AND Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines (2004) 
In high-risk persons, the recommended LDL-C goal is < 100 mg/dL. 

* An LDL-C goal of < 70 mg/dL is a therapeutic option on the basis of available clinical trial evidence, especially for patients at very high risk. 
* If LDL-C is > 100 mg/dL, an LDL-lowering drug is indicated simultaneously with lifestyle changes. 
* If baseline LDL-C is < 100 mg/dL, institution of an LDL-lowering drug to achieve an LDL-C level  
< 70 mg/dL is a therapeutic option on the basis of available clinical trial evidence. 
* If a high-risk person has high triglycerides or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug. When triglycerides are > 200 mg/dL, non-HDL-C is a secondary target of therapy, with a goal 30 mg/dL higher than the identified LDL-C goal. 

The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening men aged 35 and older for lipid disorders and recommends screening men aged 20 to 35 for lipid disorders if they are at increased risk for coronary heart disease. The USPSTF also strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease and recommends screening women aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease.
Improvement Notation
Higher score indicates better quality
Reference
Centers for Disease Control and Prevention (CDC). 2005. "Trends in cholesterol screening and awareness of high blood cholesterol - United States, 1991-2003." MMWR 54;865-870.
Reference
Carroll, M.D., D.A. Lacher, P.D. Sorlie, J.I. Cleeman, D.J. Gordon, M. Wolz, S.M. Grundy, C.L. Johnson. 2005. "Trends in serum lipids and lipoproteins of adults. 1960-2002." JAMA 294:1773-1781.
Reference
Centers for Disease Control and Prevention (CDC). 2000. "State-specific cholesterol screening trends - United States, 1991-1999." MMWR 49:750-755.
Reference
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). 2002. "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report." Circulation 106(25):3143-421. 
Reference
Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227-39.
Reference
U.S. Preventive Services Task Force. 2008. "Screening for lipid disorders in adults" (June) http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm 
Definition
None
Guidance
Only patients who were diagnosed with acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) are included in this measure
Transmission Format
None
Initial Population
Patients 18 years of age and older with a visit during the measurement year who had an AMI, CABG, or PCI during the 12 months prior to the measurement year or who had a diagnosis of IVD during the measurement year
Denominator
Equals Initial Population
Denominator Exclusions
None
Numerator
Numerator 1: Patients with a complete lipid profile performed during the measurement period
Numerator 2: Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dL
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
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 Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
None