Download Indicator

Quality Indicator
Population Definition
(ICD-9/RFV codes)1
Prominent Exclusions1
Unmeasured
Exceptions1
Quality Indicator Performance Definition2
1. Warfarin Use in
Atrial Fibrillation
ICD-9 427.31
Non-adherence,
fall risk
Warfarin, Heparin, Enoxaparin,
Dicumarol, Clopidogel, Anisindione
2. ACE inhibitors
in Heart Failure
ICD-9 428, 398.91,
402.01, 402.11,
402.91, 404.01,
404.03, 404.11,
404.13, 404.91,
404.93
RFV 2520.0
ICD-9 401-405
RFV 2505.0, 2510.0
GI bleeding, Gastritis & duodenitis
Alcoholism/drug abuse, Gait abnormality
Alzheimer disease, Cerebral hemorrhage
Seizure disorder, CNS tumors, Renal insufficiency,
Thrombocytopenia
Hyperkalemia
Allergy
CAD, DM, HTN
DM, CAD, CHF
Failure of
previous trials
ICD-9 410-414
429.0, 429.1, 429.2,
429.5, 429.6, 429.7
RFV 2515.0
As above in #4.
GI bleeding, Gastritis & duodenitis,
Cerebral hemorrhage, Alcoholism/drug abuse
Allergy
ACEI
Benazepril HCL, Captopril, Enalaprilat/enalapril,
maleate, Fosinopril sodium, Quinapril HCL,
Ramipril, Lisinopril, Perindopril erbumine,
Moexipril, Trandolapril
ARB
Losartan Potassium, Irbesartan, Valsartan
DIURETICS
Isosorbide, Torsemide, Bendroflumethiazide,
Benzthiazide, Chlorothiazide, Chlorthalidone,
Cyclothiazide, Hydrochlorothiazide,
Hydroflumethiazide, Indapamide, Methyclothiazide,
Metolazone, Polythiazide,
Quinethazone, Trichlormethiazide, Bumetanide,
Ethacrynic acid/ethacrynate sodium, Furosemide,
BB
Timolol, Nadolol, Propranolol, Penbutolol sulfate,
Metoprolol, Labetalol HCL, Atenolol,
Pindolol, Acebutolol HCL, Sotalol HCL,
Esmolol HCL, Carvedilol, Bisoprolol fumarate,
Betaxolol HCL, Levobunolol HCL
Aspirin, Warfarin, Heparin, Enoxaparin,
Dicumarol, Clopidogel, Anisindione
Heart block, Asthma, COPD
Intolerance to
previous trial
HTN, past MI
6. Antibiotic use in
uncomplicated UTI
ICD-9 595.0, 595.9,
599.0 in females with
acute visits
RFV 1665.2, 1675.0,
2700.0
Allergy,
recurrent UTI
7. Antibiotic use in
uncomplicated sore
throat
ICD-9 034.0
Infections of bacterial origin, Other infections
(Skin infections, Vaginitis/cervicitis, Infections of
kidney, Sexually transmitted disease),
Nephrolithiasis, DM, Cancer, HIV/AIDS,
Urological procedures, Urological
structural/functional abnormality, Pregnancy
DM, HIV/AIDS, Cancer, Infections of bacterial
origin, Complicated sore throat, Pre-/postoperative
visits, Injury-induced visits
Timolol, Nadolol, Propranolol, Penbutolol sulfate,
Metoprolol, Labetalol HCL, Atenolol,
Pindolol, Acebutolol HCL, Sotalol HCL,
Esmolol HCL, Carvedilol, Bisoprolol fumarate,
Betaxolol HCL, Levobunolol HCL
SMX/TMP, TMP, Ciprofloxacin, Ofloxacin,
Norfloxacin, Amoxicillin, Nitrofurantoin
3. Diuretics or Beta
blockers in
uncomplicated
hypertension
4. Aspirin in CAD
5. Beta blockers in
CAD
Allergy,
recurrent sore
throat
Penicillin, Erythromycin
Co-Morbidities
Used for Risk
Adjustment3
Past Stroke,
CHF
Hyperlipidemia,
HTN
Quality Indicator
Population Definition
(ICD-9/RFV codes)1
Prominent Exclusions1
8. No antibiotics in
uncompli-cated
URI
ICD-9 79.99, 460,
465, 487.1
RFV 1445.0, 1450.0,
2600.0
ICD-9 381.0, 382
RFV 2450.0
ICD-9 493
RFV 2625.0
Bronchospasm, DM, HIV/AIDS, Other sexually
transmitted disease, Cancer, Infections of bacterial
origin, Potential bacterial infections of respiratory
system
Age > 18, Infections of bacterial origin
Recurrence
COPD, No beta agonist listed
Mild asthma
11. Anxiolytics in
depression
ICD-9 296.2, 296.3,
300.4, 309.0, 309.1,
311.0
RFV 1110.0
Anxiety disorder
12. Depression
treatment
As above in #11
14. Diet advice in
hyper-lipidemia
with comorbidities
15. Diet advice in
obesity with comorbidities
16. Smoking
cessation advice in
smoking with comorbidities
17. Adolescent
prevention
18. Dietary advice
ICD-9 272.0-272.4
with DM, CAD or
Obesity
ICD-9 278.0
RFV 1040.0 with DM,
HTN, CHF
Smoker with CAD,
COPD, Asthma, CHF,
DM, others
Age > 85 years
Age 12 to 17 years
None
ICD-9 250, RFV
None
9. Antibiotics in
otitis media
10. Inhaled steroids
in asthma
None
Non-smokers
Unmeasured
Exceptions1
Quality Indicator Performance Definition2
Antibiotics not listed as medication (LIST TO BE
PROVIDED BY RANDY)
Visit with
advice provided
or dietician care
Visit with
advice provided
or dietician care
Visit with
advice provided
Recent visit
with prevention
Visit with
Co-Morbidities
Used for Risk
Adjustment3
Chronic
conditions
Amoxicillin, Cefuroxime, Ceftriaxone, Cefprozil,
Loracarbef, Cefixime, Cefpodoxime
Inhaled Steroids
Beclomethasone dipropionate, Budesonide,
Flunisolide, Fluticasone propionate,
Triamcinolone acetonide
Beta2-agonists
Salmeterol, Albuterol, Bitolterol, Pirbuterol,
Terbutaline, Metaproterenol sulfate, Levalbuterol
HCL, Isoproterenol
Benzodiazepines
Alprazolam, Chlordiazepoxide, Clorazepate
dipotassium, Clonazepam, Diazepam, Estazolam,
Flurazepam, Halazepam, Lorazepam, Oxazepam,
Prazepam, Quazepam, Temazepam, Triazolam
Tricyclics & Tetrac
Amitriptyline Hcl, Nortriptyline Hcl, Doxepin,
Imipramine Hcl, Desipramine Hcl, Amoxapine
Maprotiline Hcl, Trimipramine Maleate
SSRI/SNRI
Fluoxetine Hcl, Paroxetine Hcl, Sertraline Hcl,
Citalopram Hcl, Venlafaxine Hcl
NEW GEN ANTI-DEP
Bupropion Hcl, Nefazodone Hcl, Trazodone Hcl,
Mirtazapine
Monoamine Oxidase Inhibitors
Tranylcypromine, Phenelzine, Isocarboxazid
Diet/nutrition advice provided
Diet/nutrition advice provided
CAD, COPD,
CHF, DM
Smoking cessation advice provided
CAD, COPD,
Pregnancy
Advice on diet, exercise or weight
Asthma, other
conditions
HTN, CAD,
Dietary advice provided
Prominent Exclusions1
Population Definition
(ICD-9/RFV codes)1
in diabetes with comorbidities
2205.0 with HTN,
CAD, hyperlipidemia
19. Management of
self-inflicted
injuries
20. Smoking status
assessment
21. Hypertension
screening
22. Appropriate
HIV screening
follow-up
23. Appropriate
Screening ECG use
Reported intentional,
self-inflicted injury
None
All
None
None
Determination smoker/non-smoker
All
None
Visit with BP
measurement
Blood pressure measurement done
HIV serology ordered
None
All
General exam,
DM, smoking
All
Pre-op visit,
need for job
clearance
None
Avoidance of ECG screening except where
indicated
24. Appropriate
Screening U/A use
25. Appropriate
Screening CBC use
26. High risk drugdrug interactions
Cardiac disease, Chest pain, HTN, Palpitations,
Dysnea, Syncope, Hemoptysis, Chest trauma,
Renal failure
Urologic disease, pregnancy, relevant diseases of
genital organs
Hematologic, oncologic, infecection, fatigue
No urinalysis performed
General exam
None
Avoidance of CBC use except in indicated patients
General exam
All with 2+
medications
None
Avoidance of drug combinations posing a high risk
for adverse drug events
Multiple chronic
conditions
27. High risk drugpatient interactions
All with 1+
medications
None
Close
monitoring in
unusual cases
Close
monitoring in
unusual cases
Avoidance of drugs contraindicated in specific
conditions
Multiple chronic
conditions
28. Strep test
among patients
diagnosed with
sore throat
29. Appropriate
follow-up in AOM
ICD-9 034.0
% of patients diagnosed with sore throat for whom a
strep test was ordered
ICD-9 381.0, 382
RFV 2450.0 in
children < 5 y with
acute visits
Specific follow-up visit planned
All
Unmeasured
Exceptions1
Quality Indicator Performance Definition2
Quality Indicator
advice provided
or dietician care
Specific follow-up visit planned or hospitalized
Co-Morbidities
Used for Risk
Adjustment3
obesity,
hyperlipidemia,
renal disease
Depression,
schizoprenia
CAD, COPD,
Pregnancy, DM
CAD,
Specific follow-up visit planned
30. Lipid-lowering
meds in CAD
31.
Pharmacotherapy
in DM
1
In calculating each quality indicator, the denominator is a specific group of patient visits for which the quality indicator would apply (refer to population definitions) excluding certain
visits where contraindications exist for the application of the quality indicator (refer to prominent exclusions). In most cases, population definitions and prominent exclusions are
identified by specific ICD-9-CM and reason-for-visit (RFV) codes. An attempt was made to list other conditions that are potentially contraindicative of the application of the quality
indication but are measured in N(H)AMCS (refer to unmeasured exceptions). These unmeasured exceptions should not affect the results so long as there is no reason to believe they are of
significant frequency or not randomly distributed among the predictor variables of interest.
2
In calculating each quality indicator, the numerator is to define specific physician actions that indicate performance of high quality care according to evidence-base clinical guidelines. In
cases where medication use is the performance measure, please note that medications were listed as of 2000.
3
Comorbidities are confounders that could influence the performance of the quality indicator. These conditions will be used as case-mix variables in risk adjustment for assessing the
performance of the quality indicator.