CQM PQRI Vendor Required Measures

CQM and PQRI Vendor Required Reports

0001 AMA: Asthma Assessment

• Percentage of patients aged 5 through 40 years with a diagnosis of asthma and who have been seen for at least 2 office visits, who were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms.

0002 NCQA: Appropriate Testing for Children with Pharyngitis

• The percentage of children 2–18 years of age who were diagnosed with Pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.

0004 NCQA: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:

• a. Initiation, b. Engagement
• The percentage of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

0012 AMA: Prenatal Care: Screening for Human Immunodeficiency Virus (HIV)

• Percentage of patients, regardless of age, who gave birth during a 12-month period who were screened for HIV infection during the first or second prenatal visit.

0013 AMA: Hypertension: Blood Pressure Measurement

• Percentage of patient visits for patients aged 18 years and older with a diagnosis of hypertension who have been seen for at least 2 office visits, with blood pressure (BP) recorded.

0014 AMA: Prenatal Care: Anti-D Immune Globulin

• Percentage of D (Rh) negative, unsensitized patients, regardless of age, who gave birth during a 12-month period who received anti-D immune globulin at 26-30 weeks gestation.

0018 NCQA: Controlling High Blood Pressure

• The percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose BP was adequately controlled during the measurement year.

0024 NCQA: Weight Assessment and Counseling for Children and Adolescents

• The percentage of patients 2-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year.

0027 NCQA: Smoking and Tobacco Use Cessation, Medical assistance:

• The percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies.
  • 0028a AMA: Preventive Care and Screening Measure Pair: a.Tobacco Use Assessment===
    • Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months.
  • 0028b AMA: Preventive Care and Screening Measure Pair: b.Tobacco Cessation Intervention===
    • Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months who received cessation intervention.

0031 NCQA: Breast Cancer Screening

• The percentage of women 40–69 years of age who had a mammogram to screen for breast cancer.

0032 NCQA: Cervical Cancer Screening

• The percentage of women 21-64 years of age who received one or more Pap tests to screen for cervical cancer.

0033 NCQA: Chlamydia Screening for Women

• The percentage of women 15-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.

0034 NCQA: Colorectal Cancer Screening

• The percentage of adults 50–75 years of age who had appropriate screening for colorectal cancer.

0036 NCQA: Use of Appropriate Medications for Asthma

• The percentage of patients 5-50 years of age during the measurement year who were identified as having persistent asthma and were appropriately prescribed medication during the measurement year. Report three age stratifications (5-11 years, 12-50 years, and total).

0038 NCQA: Childhood immunization Status

• The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates.

0041 AMA: Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old

• Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

0043 NCQA: Pneumonia Vaccination Status for Older Adults

• The percentage of patients 65 years of age and older as of January 1 of the measurement year who have ever received a pneumococcal vaccine.

0047 AMA: Asthma Pharmacologic Therapy

• Percentage of patients aged 5 through 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment.

0052 NCQA: Low Back Pain: Use of Imaging Studies

• The percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of diagnosis.

0055 NCQA: Diabetes: Eye Exam

• The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had a retinal or dilated eye exam or a negative retinal exam (no evidence of retinopathy) by an eye care professional .

0056 NCQA: Diabetes: Foot Exam

• The percentage of patients aged 18-75 years with diabetes (type 1 or type 2) who had a foot exam (visual inspection, sensory exam with monofilament, or pulse exam).

0059 NCQA: Diabetes: HbA1c Poor Control

• The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%.

0061 NCQA: Diabetes: Blood Pressure Management

• The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had BP <140/90 mmHg.

0062 NCQA: Diabetes: Urine Screening

• The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had a nephropathy screening test or evidence of nephropathy .

0064 NCQA: Diabetes: LDL Management & Control

• The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had LDL-C <100mg/dL.

0067 AMA: Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD

• Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed oral antiplatelet therapy.

0068 NCQA: Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic

• The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1–November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of use of aspirin or another antithrombotic during the measurement year.

0070 AMA: Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)

• Percentage of patients aged 18 years and older with a diagnosis of CAD and prior MI who were prescribed beta-blocker therapy.

0073 NCQA: Ischemic Vascular Disease (IVD): Blood Pressure Management

• The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1–November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and whose most recent blood pressure is in control (<140/90 mmHg).

0074 AMA: Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol

• Percentage of patients aged 18 years and older with a diagnosis of CAD who were prescribed a lipid-lowering therapy (based on current ACC/AHA guidelines).

0075 NCQA: Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control

• The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) from January 1–November 1 of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had a complete lipid profile performed during the measurement year and whose LDL-C was <100 mg/dL.

0081 AMA: Heart Failure (HF) : Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

• Percentage of patients aged 18 years and older with a diagnosis of heart failure and LVSD (LVEF < 40%) who were prescribed ACE inhibitor or ARB therapy.

0083 AMA: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

• Percentage of patients aged 18 years and older with a diagnosis of heart failure who also have LVSD (LVEF < 40%) and who were prescribed beta-blocker therapy.

0084 AMA: Heart Failure (HF) : Warfarin Therapy Patients with Atrial Fibrillation

• Percentage of all patients aged 18 and older with a diagnosis of heart failure and paroxysmal or chronic atrial fibrillation who were prescribed warfarin therapy.

0086 AMA: Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

• Percentage of patients aged 18 years and older with a diagnosis of POAG who have been seen for at least 2 office visits, who have an optic nerve head evaluation during one or more office visits within 12 months.

0088 AMA: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

• Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months.

0089 AMA: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

• Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the on-going care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.

0105 NCQA: Anti‐depressant medication management: (a) Effective Acute Phase Treatment, (b)Effective Continuation Phase Treatment

• The percentage of patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment.

0385 AMA: Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

• Percentage of patients aged 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period.

0387 AMA: Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

• Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period.

0389 AMA: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

• Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer

0421 QIP: Adult Weight Screening and Follow-Up

• Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented.

0575 NCQA: Diabetes: HbA1c Control (<8%)

• The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had HbA1c <8.0%.