Members with diabetes (Type 1 and Type 2) age 18 through 75 years of age as of Diabetes mellitus; low-density lipoprotein cholesterol (LDL-C); screening …
DESCRIPTIONS OF MEASURES INCLUDED IN THE NEW YORK MULTI-PAYER DATA REPORT
The following information is compiled from the Agency for Healthcare
Research and Quality wwwahrqgov and the National Committee on Quality
Assurance NCQA measures - HEDIS 2005 Volume 2: Technical Specifications,
available from the NCQA Web site at wwwncqaorg
BREAST CANCER SCREENING: percentage of women 50 to 69 years of age who had
one or more mammograms during the measurement year or the year prior to the
measurement year
DESCRIPTION
This measure is used to assess the percentage of women 50 through 69 years
of age who had one or more mammograms during the measurement year or year
prior to the measurement year
RATIONALE
Breast cancer is the second most common type of cancer among American
women, with approximately 192,000 new cases reported each year It is most
common in women over 50 Women whose breast cancer is detected early have
more treatment choices and better chances for survival Mammography
screening has been shown to reduce mortality by 20 to 30 among women 40
and older
The US Preventive Services Task Force, the American Academy of Family
Physicians and the American College of Preventive Medicine
recommend
mammograms as the most effective method for detecting breast cancer when it
is most treatable When high-quality equipment is used and well-trained
radiologists read the x-rays, 85-90 percent of cancers are detectable
PRIMARY CLINICAL COMPONENT
Breast cancer; screening mammography
DENOMINATOR DESCRIPTION
Women 52 through 69 years of age as of December 31 of the measurement year
NUMERATOR DESCRIPTION
One or more mammograms during the measurement year or the year prior to the
measurement year
EXCLUSION Optional
Exclude women who had a bilateral mastectomy and for whom administrative
data does not indicate that mammogram was performed The MCO should look
for evidence of a bilateral mastectomy as far back as possible in the
members history, either through administrative data or medical record
review If the MCO finds evidence of two separate mastectomies, it may
exclude the member from the measure The bilateral mastectomy must have
occurred by December 31st of the measurement year
DATA SOURCE
Administrative claims/encounter data
ORIGINAL TITLE
Breast cancer screening BCS
MEASURE SET NAME
Effectiveness of Care
DEVELOPER
National Committee for Quality Assurance
INCLUDED
IN
Ambulatory Care Quality Alliance
RELEASE DATE: 1993 Jan
REVISION DATE: 2005 Jan
MEASURE AVAILABILITY
The individual measure, Breast Cancer Screening BCS, is published in
HEDIS 2005 Health plan employer data information set Vol 2, Technical
specifications For more information, contact the National Committee for
Quality Assurance NCQA at 2000 L Street, NW, Suite 500, Washington, DC
20036; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: wwwncqaorg
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CERVICAL CANCER SCREENING: percentage of women 18 to 64 years of age who
received one or more Pap tests during the measurement year or the two years
prior to the measurement year
DESCRIPTION
This measure is used to assess the percentage of women 18 through 64 years
of age who received one or more Pap tests during the measurement year or
the two years prior to the measurement year
RATIONALE
When detected and treated early cervical cancer is one of the most
treatable cancers, and routine Pap smears are the preferred method for
detecting cervical cancer at the precancerous stage Having this measure
provides additional emphasis on the importance of routine Pap tests at
regular intervals
and promotes an important primary prevention test
PRIMARY CLINICAL COMPONENT
Cervical cancer; screening; Papanicolaou Pap smear
DENOMINATOR DESCRIPTION
Women 21 through 64 years of age as of December 31 of the measurement year
NUMERATOR DESCRIPTION
One or more Pap tests during the measurement year or the two years prior to
the measurement year
EXCLUSION Optional
Women who have had a hysterectomy and who have no residual cervix and for
whom the administrative data does not indicate that a Pap test was
performed The MCO should look for the evidence of a hysterectomy as far
back as possible in the members history, through either administrative
data or medical record review
DATA SOURCE
Administrative data claims or medical record review The documentation in
the medical record must include both of the following: a note indicating
the date the test was performed, and the result or finding
ORIGINAL TITLE
Cervical cancer screening CCS
MEASURE COLLECTION
HEDIS 2006: Health Plan Employer Data and Information Set
MEASURE SET NAME
Effectiveness of Care
DEVELOPER
National Committee for Quality Assurance
INCLUDED IN
Ambulatory Care Quality Alliance
RELEASE DATE: 1996 Jan
REVISION DATE: 2005
Jan
MEASURE STATUS
This is the current release of the measure
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COLORECTAL CANCER SCREENING: percentage of adults 50 to 80 years of age who
had appropriate screening for colorectal cancer
DESCRIPTION
This measure is used to assess the percentage of adults 50 to 80 years of
age who had appropriate screening for colorectal cancer
RATIONALE
Colorectal cancer CRC is the second leading cause of cancer-related death
in the United States It places significant economic burden on society,
with treatment costing over 65 billion per year Unlike other screening
tests that only detect disease, some methods of CRC screening can detect
premalignant polyps and guide their removal, which in theory can prevent
development of colon cancer
PRIMARY CLINICAL COMPONENT
Colorectal cancer; screening; fecal occult blood test; flexible
sigmoidoscopy; double contrast barium enema; colonoscopy
DENOMINATOR DESCRIPTION
Health plan members age 51 through 80 years as of December 31st of the
measurement year
NUMERATOR DESCRIPTION
One or more screenings for colorectal cancer Appropriate screenings must
meet one of four criteria:
Fecal occult blood test FOBT during
the measurement year
Flexible sigmoidoscopy during the measurement year or the four years
prior to the measurement year
Double contrast barium enema DCBE during the measurement year or the
four years prior to the measurement year Air contrast enema is a
clinical symptom
Colonoscopy during the measurement year or the nine years prior to the
measurement year
Exclusion Optional
Members with a diagnosis of colorectal cancer The MCO should look for
evidence of colorectal cancer as far back as possible in the members
history, through either administrative data or medical record review
DATA SOURCE
Administrative claims data and medical record review The documentation
in the medical record must include both of the following: a note indicating
the date the colorectal cancer screening was performed and the result or
finding
ORIGINAL TITLE
Colorectal cancer screening COL
MEASURE COLLECTION
HEDIS 2006: Health Plan Employer Data and Information Set
DEVELOPER
National Committee for Quality Assurance
INCLUDED IN: Ambulatory Care Quality Alliance
ADAPTATION: Measure was not adapted from another source
RELEASE DATE: 2004 Jan
REVISION DATE: 2005 Jan
MEASURE
STATUS
This is the current release of the measure
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COMPREHENSIVE DIABETES CARE: percentage of members with diabetes mellitus
type 1 and type 2 who had a hemoglobin A1c HbA1c test during the
measurement year
DESCRIPTION
This measure is used to assess the percentage of members 18 through 75
years of age with diabetes Type 1 and Type 2 who were continuously
enrolled during the measurement year and who had a hemoglobin A1c HbA1c
blood test
This measure is a component of a composite measure; it can also be used on
its own
RATIONALE
Effective use of hemoglobin A1c HbA1c testing is an important means to
minimize further health risks from diabetes This measure is consistent
with the National Diabetes Quality Improvement Alliance NDQIA set of
measures
PRIMARY CLINICAL COMPONENT
Diabetes mellitus; hemoglobin A1c HbA1c
DENOMINATOR DESCRIPTION
Members with diabetes Type 1 and Type 2 age 18 through 75 years of age as
of December 31 of the measurement year
NUMERATOR DESCRIPTION
One or more hemoglobin A1c HbA1c test performed during the measurement
year as identified by administrative claims data or medical record
review
DATA SOURCE
Administrative
data
Laboratory data
Pharmacy data
ORIGINAL TITLE
Comprehensive diabetes care CDC [hemoglobin A1c HbA1c tested]
MEASURE COLLECTION
HEDIS 2006: Health Plan Employer Data and Information Set
COMPOSITE MEASURE NAME
Comprehensive Diabetes Care CDC
DEVELOPER
National Committee for Quality Assurance
INCLUDED IN
Ambulatory Care Quality Alliance
RELEASE DATE 1999 Jan
REVISION DATE 2005 Jan
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COMPREHENSIVE DIABETES CARE: percentage of members with diabetes mellitus
type 1 and type 2 who had low-density lipoprotein cholesterol LDL-C
screening performed
DESCRIPTION
This measure is used to assess the percentage of members 18 to 75 years
with diabetes Type 1 and Type 2 who were continuously enrolled during the
measurement year and who had low-density lipoprotein cholesterol LDL-C
test performed during the measurement year or prior to the measurement
year
This measure is a component of a composite measure; it can also be used on
its own
RATIONALE
Effective use of low-density lipoprotein cholesterol LDL-C screening and
control is an important means to minimize further health risks from
diabetes This measure is consistent with the National Diabetes
Quality
Improvement Alliance NDQIA set of measures
PRIMARY CLINICAL COMPONENT
Diabetes mellitus; low-density lipoprotein cholesterol LDL-C; screening
DENOMINATOR DESCRIPTION
Members with diabetes Type 1 and Type 2 age 18 through 75 years of age as
of December 31 of the measurement year
NUMERATOR DESCRIPTION
A low-density lipoprotein cholesterol LDL-C test performed during the
measurement year or year prior to the measurement year, as identified by
claim/encounter or automated laboratory data
DATA SOURCE
Administrative data, Laboratory data, Pharmacy data
Identifying Information
ORIGINAL TITLE
Comprehensive diabetes care CDC [LDL-C screening performed]
MEASURE COLLECTION
HEDIS 2006: Health Plan Employer Data and Information Set
MEASURE SET NAME
Effectiveness of Care
COMPOSITE MEASURE NAME
Comprehensive Diabetes Care CDC
DEVELOPER
National Committee for Quality Assurance
INCLUDED IN
Ambulatory Care Quality Alliance
RELEASE DATE 1999 Jan
REVISION DATE 2005 Jan
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COMPREHENSIVE DIABETES CARE: percentage of members with diabetes mellitus
type 1 and type 2 who were monitored for kidney disease nephropathy
DESCRIPTION
This measure is used to
assess the percentage of members 18 to 75 years of
age with diabetes Type 1 and Type 2 who were continuously enrolled during
the measurement year and who were monitored for kidney disease
nephropathy
This measure is a component of a composite measure; it can also be used on
its own
RATIONALE
Effective use of monitoring for nephropathy is an important means to
minimize further health risks from diabetes This measure is consistent
with the National Diabetes Quality Improvement Alliance NDQIA set of
measures
PRIMARY CLINICAL COMPONENT
Diabetes mellitus; nephropathy
DENOMINATOR DESCRIPTION
Members with diabetes Type 1 and Type 2 age 18 through 75 years of age as
of December 31 of the measurement year
NUMERATOR DESCRIPTION
Screening for nephropathy or evidence of nephropathy, as documented through
administrative data The managed care organization MCO is allowed to
count toward the numerator:
members who have been screened for urine microalbumin or
members who have nephropathy, as demonstrated by either evidence of
medical attention for nephropathy, a visit to nephrologist, or a
positive urine macroalbumin test
DATA SOURCE
Administrative data
Laboratory
data
Pharmacy data
ORIGINAL TITLE
Comprehensive diabetes care CDC [kidney disease nephropathy monitored]
MEASURE COLLECTION
HEDIS 2006: Health Plan Employer Data and Information Set
MEASURE SET NAME
Effectiveness of Care
COMPOSITE MEASURE NAME
Comprehensive Diabetes Care CDC
DEVELOPER
National Committee for Quality Assurance
ADAPTATION
Measure was not adapted from another source
RELEASE DATE: 1999 Jan
REVISION DATE: 2005 Jan
Source:nybgh.org
