Appendx __: Quality Measures Following are three tables that list
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Appendx __: Quality Measures Following are three tables that list the quality measures used in the study. Tables 1 and 2 provide lists of clinical process measures for adults (>20 years) and children and adolescents (<21 years), respectively. Tables 1&2 are based on the Medicaid initial core sets of adult and child health quality measures as recently developed by the US Department of Health and Human Services pursuant to the Patient Protection and Affordable Care Act (PPACA) and the Children’s Health Insurance Program Reauthorization Act (CHIRPA). Measures selected from (or added to) these initial core sets to accommodate the following considerations: 1) feasibly measured with administrative data only; 2) broadly representative across age groups, gender; 3) broadly representative of treatment levels including prevention, acute and chronic condition care; and,4) and broadly representative of physical and behavioral conditions. As noted in the table, all measures will be modified to accommodate calculation using a single year of administrative data per individual. Table 3 provides a list of prevention quality measures that reflect intermediate outcomes of underlying (primary) clinical treatment quality. These are based on the Prevention Quality Indicators (PQIs) developed by the Agency for Health Care Research and Quality (AHRQ). Included in this group is an additional measure for any behavioral care. These measures will be calculated separately across four dimensions: inpatient care, emergency department care (without inpatient admission), adults, and children and adolescents. Within these groups we will also distinguish between measures related to acute and chronic conditions. We note that the PQIs were primarily developed for adults and many (but not all) of the specific conditions are unlikely to be present among children. Table 1: Adult (>20years) Clinical Process Measures Quality Measure Owner Treatment Physical or Level Behavioral Condition Receipt of Flu Vaccine NCQA Prevention Physical Colorectal Cancer NCQA Prevention Physical Screening Cervical Cancer Screening NCQA Prevention Physical Chlamydia Screening 21NCQA Prevention Physical 24 years Behavioral Health RAND/ Prevention Behavioral Screening CMS Use of Imaging for Low Back Pain Follow-up for Behavioral Inpatient Persistence of BetaBlocker Treatment after Heart Attack Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL Cholesterol NCQA Acute Physical NCQA Acute Behavioral NCQA Chronic Physical AMAPCPI Chronic Physical Diabetes Lipid Profile Diabetes HbA1C Diabetes eye Exam Appropriate Asthma Medication HIV/AIDS: Medical Visit Depression Acute Phase Medication Bipolar I Mood Stabilizer Use Schizophrenia: Long-term anti-psychotic use Glycemic & Lipid Assessment w/ Mood Stabilizer or Atypical Antipsychotic NCQA NCQA NCQA NCQA Chronic Chronic Chronic Chronic Physical Physical Physical Physical NCQA NCQA Chronic Chronic Physical Behavioral RAND Chronic Behavioral RAND Chronic Behavioral RAND Chronic Behavioral Annual Monitoring for Patients with Persistent Medications RAND Chronic Physical Comments or Modifications Administrative records only Measurement year only Measurement year only Generalized measure related to RAND/CMS alcohol/depression screening . CPT/HCPCS for any psychiatric or substance abuse related screen Include all behavioral IP (MH &SA) and use 30 day measure only. Measurement year only. 180 day treatment for live AMI discharges in first 6 months of measurement year. Diabetes in measurement year only Diabetes in measurement year only Diabetes in measurement year only Separate measurement of 12 month supply and any use Separate measurement of 12 month supply and any use Extends RAND measures for Bipolar I/Schizophrenia. Any use of an atypical antipsychotic (AP) or mood stabilizer w/o AP as separate denominators. At least one HbA1c or lipid profile as separate numerators. Table 2: Child and Adolescent (<21years) Clinical Process Measures Quality Measure Owner Treatment Level Comments or Modifications Prevention Physical or Behavioral Condition Behavioral Developmental Screening In the First Three Years of Life Behavioral Health Screening (12-20 years) NCQA/ CAHMI Rand/C MS Prevention Behavioral Generalized measure related to RAND/CMS alcohol/depression screening . CPT/HCPCS for any psychiatric or substance abuse related screen Chlamydia Screening 1620 years Well Care NCQA Prevention Physical NCQA Prevention Physical Appropriate Testing for Pharyngitis NCQA Acute Physical Otitis Media with Effusion (OME) –Inappropriate Use of Antimicrobials AMAPCPI Acute Physical Follow-up for Behavioral Inpatient Diabetes HbA1C Appropriate Asthma Medication Glycemic & Lipid Assessment w/ Mood Stabilizer or Atypical Antipsychotic NCQA Acute Behavioral NCQA NCQA Chronic Chronic Physical Physical RAND Chronic Behavioral Separate rates for <15mo., 3-6 years, 12-21years. Include all behavioral IP (MH &SA) and use 30 day measure only. Diabetes in measurement year only Extends RAND measures for Bipolar I/Schizophrenia. Any use of an a typical antipsychotic (AP) or mood stabilizer w/o AP as separate denominators. At least one HbA1c or lipid profile as separate numerators. Table 3: All Age Prevention Quality Measures Quality Measure Source Acute or Chronic Condition Physical or Behavioral Condition Comments or Modifications Diabetes, short-term complications AHRQ PQI #1 Chronic Physical IP and ED, child and adult use separately. Perforated appendicitis AHRQ PQI #2 Acute Physical IP and ED, child and adult use separately. Diabetes, long-term complications AHRQ PQI #3 Chronic Physical IP and ED, child and adult use separately. Chronic obstructive pulmonary disease AHRQ PQI #5 Chronic Physical IP and ED, child and adult use separately. Hypertension AHRQ PQI #7 Chronic Physical IP and ED, child and adult use separately. Congestive heart failure AHRQ PQI #8 Chronic Physical IP and ED, child and adult use separately. Dehydration AHR PQI#10 Acute Physical IP and ED, child and adult use separately. Bacterial pneumonia AHR PQI#11 Acute Physical IP and ED, child and adult use separately. Urinary infections AHRQ PQI#12 Acute Physical IP and ED, child and adult use separately. Angina without procedure AHRQ PQI#13 Chronic Physical IP and ED, child and adult use separately. Uncontrolled diabetes AHRQ PQI#14 Chronic Physical IP and ED, child and adult use separately. Asthma AHRQ PQI#15 Chronic Physical IP and ED, child and adult use separately. Lower extremity amputations among patients with diabetes AHRQ PQI#16 Chronic Physical IP and ED, child and adult use separately. NA Chronic Behavioral IP and ED, child and adult use separately. Behavioral Care
