Table. Abbreviated Descriptions of Outcome Measures
Measure
(Abbreviation)
Numerator
Denominator
Use of Appropriate
Medications for
People with Asthma
(ASM)
Subset of denominator
members who were
dispensed at least one
prescription for asthma
controller medication
during the
measurement year
Members 21-64 years old enrolled in the
measurement year and the preceding year
meeting one of the following criteria
during the measurement year and the
preceding year:
> 1 ED visit with asthma as
principal diagnosis
- > 1 acute inpatient encounter with
asthma as principal diagnosis
- > 4 outpatient visits with asthma as
a diagnosis, including two asthma
medication dispensing events
- > four asthma medication
dispensing events
Exclude:
-
-members with a diagnosis of emphysema,
COPD, chronic bronchitis, cystic fibrosis,
or acute respiratory failure
Medication
Management for
People With
Asthma (MMA)
Subset of denominator
members who were
dispensed asthma
controller medication
covering at least 75%
of the treatment period
Members 21-64 years old enrolled in
measurement year and preceding year
with persistent asthma (as identified in
ASM)
Exclude:
-members with a diagnosis of emphysema,
COPD, chronic bronchitis, cystic fibrosis,
or acute respiratory failure
Pharmacotherapy
Management of
COPD Exacerbation
(PCE)
Numerator 1 - systemic
corticosteroid: subset of
denominator events for
which members were
dispensed a
prescription for
Members 40-64 years old with an acute
inpatient discharge or ED encounter with a
principal diagnosis of COPD during the
measurement year who were enrolled for >
30 days of the exacerbation event
systemic corticosteroid
< 14 days of the event
date
Numerator 2 bronchodilator: subset
of denominator events
for which members
were dispensed a
prescription for
bronchodilator < 30
days of the event date
Cholesterol
Management for
Patients With
Cardiovascular
Conditions (CMC)
Numerator 1 – LDL-C
Screening: subset of
denominator members
who had an LDL-C test
in the measurement
year
Exclude:
-ED visits that resulted in an inpatient
admission
-event dates for which member was
transferred directly to an acute or non
acute care facility for any diagnosis
-event dates for which the member was
readmitted to an acute or non-acute care
facility, or had an ED visit for any
diagnosis, within 14 days of the event date
Members 21-64 years old enrolled in the
measurement year and preceding year
discharged for AMI, CABG or PCI in the
year preceding the measurement year or
with a diagnosis of IVD in the
measurement year and the preceding year
Numerator 2 – LDL-C
Control – subset of
denominator members
whose most recent
LDL-C <100 mg/dL
during the
measurement year
Persistence of BetaBlocker Treatment
After a Heart Attack
(PBH)
Subset of denominator
members who received
treatment with betablockers with ≥ 135
days supplied for the
180 days after
discharge (> 75% of
days)
Members 21-64 years old discharged from
an acute inpatient setting with an acute
myocardial infarction (AMI) between July
1 of year preceding the measurement year
through June 30th of the measurement year
and enrolled for > 6 months of discharge
date
Exclude:
-hospitalizations in which member
transferred directly to non-acute care
facility for any diagnosis
Comprehensive Diabetes Care (CDC)
HbA1c testing
Subset of denominator
members who had an
HbA1c test during the
measurement year
Members 21-64 years old enrolled during
the measurement year diagnosed with type
1 or type 2 diabetes (type 1 and type 2) in
the measurement year or the preceding
year through
EITHER
-
two face-to-face outpatient or nonacute inpatient encounters with a
diagnosis of diabetes or
one face-to face ED or acute
inpatient encounter with a
diagnosis of diabetes
OR
-
dispensed insulin or
hypoglycemics/antihyperglycemics
on ambulatory basis
Exclude:
-members discharged with CABG or PCI
-members with a diagnosis of IVD, CHF,
MI, CRF/ESRD, dementia, blindness, or
lower extremity amputation
Eye exam
Subset of denominator
members who had an
eye screening for
diabetic retinal disease
identified by a retinal
or dilated eye exam by
an eye care
professional in the
measurement year OR
a negative retinal exam
Same as HbA1c testing
by an eye care
professional in the year
preceding the
measurement year
LDL-C screening Subset of denominator
members who received
an LDL-C test during
the measurement year
Same as HbA1c testing
Nephropathy
screening
Same as HbA1c testing
Subset of denominator
members who received
a nephropathy
screening test during
the measurement year
OR have evidence of
nephropathy
Source: HEDIS 2012 Technical Specifications for Health Plans, Volume 2. Washington,
DC: National Committee on Quality Assurance; 2011.