Public listing of 2017 CUHSM Non-Program measures - CUHSM.ORG
Narrative version here Downloadable spreadsheet
here
|
Measure ID |
Measure Title |
Measure Description |
NQS Domain |
Numerator |
Denominator |
Denominator Exclusions |
Denominator Exceptions |
Number of performance rates to be included in the XML |
Overall Performance Rate (See *) |
Measure Types |
High Priority |
Outcome |
Inverse Measure (Y/N) |
Proportional Measure (Y/N) |
Continuous Variable Measure (Y/N) |
Ratio Measure (Y/N) |
Risk-Adjusted (Y/N) |
|
CUHSM3 |
CAHPS Clinician/Group Surveys - (Adult Primary Care, Pediatric
Care, and Specialist Care Surveys) |
•Adult Primary Care Survey: 37 core and 64 supplemental question
survey of adult outpatient primary care patients.
Pediatric Care Survey: 36 core and 16 supplemental question
survey of outpatient pediatric care patients.
Specialist Care Survey: 37 core and 20 supplemental question
survey of adult outpatients specialist care patients.
Level of analysis for each of the 3 surveys: group practices,
sites of care, and/or individual clinicians |
Person and Caregiver-Centered Experience and Outcomes |
The top box numerator for the Overall Rating of Provider is the
number of respondents who answered 9 or 10 for the item, with 10
indicating “Best provider possible”. |
The measure’s denominator is the number of survey respondents.
The target populations for the surveys are patients who have had
at least one visit to the selected provider in the target
12-month time frame. This time frame is also known as the look
back period. The sampling frame is a person-level list and not a
visit-level list. |
The following are excluded when constructing the sampling frame:
• Patients that had another member of their household already
sampled.
• Patients who are institutionalized (put in the care of a
specialized institution) or deceased. |
None |
1 |
N/A |
Patient Engagement/ Experience |
High Priority |
|
N |
N |
N |
N |
Y |
|
CUHSM4 |
CAHPS Health Plan Survey v 4.0 - Adult questionnaire |
30-question core survey of adult health plan members that
assesses the quality of care and services they receive. Level of
analysis: health plan – HMO, PPO, Medicare, Medicaid,
commercial |
Person and Caregiver-Centered Experience and Outcomes |
The top box numerator for each of the four Overall Ratings items
is the number of respondents who answered 9 or 10 for the item;
with a 10 indicating the “Best possible.” |
The measure’s denominator is the number of survey respondents
who answered the question. The target population for the survey
includes all individuals who have been enrolled in a health plan
for at least 6 (Medicaid) or 12 (Commercial) months with no more
than one 30-day break in enrollment. Denominators will vary by
item and composite. |
Individuals are excluded from the survey target population if:
1) They were not continuously enrolled in the health plan
(excepting an allowable enrollment lapse of less than 30 days).
2) Their primary health coverage is not through the plan.
3) Another member of their household has already been sampled.
4) They have been institutionalized (put in the care of a
specialized institution) or are deceased. |
None |
1 |
N/A |
Patient Engagement/ Experience |
High Priority |
|
N |
N |
N |
N |
Y |
|
CUHSM6 |
Adherence to Mood Stabilizers for Individuals with Bipolar I
Disorder |
Percentage of individuals at least 18 years of age as of the
beginning of the measurement period with schizophrenia or
schizoaffective disorder who had at least two prescription drug
claims for antipsychotic medications and had a Proportion of
Days Covered (PDC) of at least 0.8 for antipsychotic medications
during the measurement period (12 consecutive months). |
Patient Safety |
Individuals with bipolar I disorder who had at least two
prescription drug claims for mood stabilizer medications and
have a PDC of at least 0.8 for mood stabilizer medications. |
Individuals at least 18 years of age as of the beginning of the
measurement period with bipolar I disorder and at least two
prescription drug claims for mood stabilizer medications during
the measurement period (12 consecutive months). |
Not Applicable |
None |
1 |
N/A |
Process |
High Priority |
|
N |
N |
N |
N |
Y |
|
CUHSM8 |
Cardiovascular Health Screening for People With Schizophrenia or
Bipolar Disorder Who Are Prescribed Antipsychotic Medications |
The percentage of individuals 25 to 75 years of age with
schizophrenia or bipolar disorder who were prescribed any
antipsychotic medication and who received a cardiovascular
health screening during the measurement year. |
Patient Safety |
Individuals who had one or more LDL-C screenings performed
during the measurement year. |
Individuals ages 25 to 75 years of age by the end of the
measurement year with a diagnosis of schizophrenia or bipolar
disorder who were prescribed any antipsychotic medication during
the measurement year. |
Individuals are excluded from the denominator if they were
discharged alive for a coronary artery bypass graft (CABG) or
percutaneous coronary intervention (PCI) (these events may occur
in the measurement year or year prior to the measurement year),
or diagnosed with ischemic vascular disease (IVD) (this
diagnosis must appear in both the measurement year and the year
prior to the measurement year), chronic heart failure, or had a
prior myocardial infarction (identified in the measurement year
or as far back as possible). |
None |
1 |
N/A |
Process |
High Priority |
|
N |
N |
N |
N |
Y |
(*) Overall Performance Rate Column label
designated as follows:
Indicate an
Overall Performance Rate if more than 1 performance rate is to be
submitted
Specify which rate will represent an overall performance rate for the
measure or how an overall performance rate could be calculated based on
the data submitted in the XML [for example, simple average of the
performance rates submitted or weighted average (sum the numerators
divided by the sum of the denominators), etc].
----------------------------------------------------------------------------
Narrative version
2017 CUHSM Non-Program
measures - CUHSM.ORG
-----------------------
ID:
CUHSM3
NQF# 0005
eCQM# NA
Measure Title: CAHPS Clinician/Group Surveys -Adult Primary
Care - Pediatric Care - Specialist Care
Surveys
Measure Description:
-Adult Primary Care Survey: 37 core and 64 supplemental question
survey of adult outpatient primary
care patients.
-Pediatric Care Survey: 36 core and 16 supplemental question survey
of outpatient pediatric care
patients.
-Specialist Care Survey: 37 core and 20 supplemental question survey
of adult outpatients specialist care
patients.
Level of analysis for each of the 3 surveys: group practices, sites
of care, and/or individual clinicians
NQS Domain: Person and Caregiver- Centered Experience and
Outcome
Numerator: Completed questionnaires. A questionnaire is
considered complete if responses are
available for half of the key survey items.
Denominator:
A random sample of the following:
o Adult Primary Care Questionnaire: Adult patients (≥18 years) who
received outpatient primary care from
any of the doctors who are the subject of the survey, OR
o Adult Specialty Care Questionnaire: Adult patients (≥18 years) who
received care from any of the
specialist doctors who are the subject of the survey OR
o Child Primary Care Questionnaire: Parents or guardians of children
who received care from any of the
doctors who are the subject of the survey.
• Survey size determined based on the number of performance levels
at which physicians are to be
distinguished, desired level of confidence about these distinctions,
expected amounts and types of
variability in survey scores, and expected response rates. Reports
of survey data should make public
statistical confidence levels and other aspects of survey and
analysis methods.
Denominator Exclusions / Exception:
-Deceased. In some cases, a household or family member may inform
you of the death of the sampled
individual or child;
-Ineligible. The sampled individual or child did not receive care
from the participating medical group or
health system in the last 12 months.
Rationale: Demonstrated ability of CG-CAHPS patient experience
surveys to reveal gaps in system
performance, to enhance loyalty to practices, increase member
satisfaction, and to correlate with better
performance on effective care processes, adherence and outcomes,
creating a system to measure
patient experience is foundational to the success of any new payment
reform model.
Measure Type (Process/Outcome): Process
Steward: ARHQ
Data Source: Survey: Patient Reported Data/Survey
ID: CUHSM4
NQF# 0006
eCQM# NA
Measure Title: CAHPS Health Plan Survey v 4.0 - Adult
questionnaire
Measure Description: 30-question core survey of adult health
plan members that assesses the quality of
care and services they receive. Level of analysis: health plan –
HMO, PPO, Medicare, Medicaid,
commercial
NQS Domain: Person and Caregiver- Centered Experience and
Outcome
Numerator: Completed questionnaires. A questionnaire is
considered complete if responses are
available for half of the key survey items.
Denominator: A random sample of the following:
o Adult Primary Care Questionnaire: Adult patients (≥18 years) who
received outpatient primary care from
any of the doctors who are the subject of the survey, OR
o Adult Specialty Care Questionnaire: Adult patients (≥18 years) who
received care from any of the
specialist doctors who are the subject of the survey OR
o Child Primary Care Questionnaire: Parents or guardians of children
who received care from any of the
doctors who are the subject of the survey.
• Survey size determined based on the number of performance levels
at which physicians are to be
distinguished, desired level of confidence about these distinctions,
expected amounts and types of
variability in survey scores, and expected response rates. Reports
of survey data should make public
statistical confidence levels and other aspects of survey and
analysis methods.
Denominator Exclusions / Exception: Deceased. In some cases,
a household or family member may
inform you of the death of the sampled individual or child;
Ineligible. The sampled individual or child did not receive care
from the participating medical group or
health system in the last 12 months.
Refusals. The individual (or parent or guardian of the sampled
child) refused in writing or by phone to
participate.
Nonresponse. The individual (or parent or guardian of the sampled
child) is presumed to be eligible but
did not complete the survey for some reason (never responded, was
unavailable at the time of the survey,
was ill or incapable, had a language barrier, and so on).
Bad addresses/phone numbers. In either case, the sampled individual
(or parent or guardian) is
presumed to be eligible but was never located
Rationale: Demonstrated ability of CG-CAHPS patient experience
surveys to reveal gaps in system
performance, to enhance loyalty to practices, increase member
satisfaction, and to correlate with better
performance on effective care processes, adherence and outcomes,
creating a system to measure
patient experience is foundational to the success of any new payment
reform model.
Measure Type (Process/Outcome): Process
Steward: AHRQ
ID:
CUHSM6
NQF# 1880
eCQM# NA
Measure Title: Adherence to Mood Stabilizers for Individuals with
Bipolar I Disorder
Measure Description: Percentage of individuals at least 18 years
of age as of the beginning of the
measurement period with schizophrenia or schizoaffective disorder who
had at least two prescription drug
claims for antipsychotic medications and had a Proportion of Days
Covered (PDC) of at least 0.8 for
antipsychotic medications during the measurement period (12 consecutive
months).
Numerator: Individuals with schizophrenia or schizoaffective
disorder who had at least two prescription
drug claims for antipsychotic medications and have a PDC of at least 0.8
for antipsychotic medications.
Denominator: Individuals at least 18 years of age as of the
beginning of the measurement period with
schizophrenia or schizoaffective disorder and at least two prescription
drug claims for antipsychotic
medications during the measurement period (12 consecutive months).
Exclusions: Individuals with any diagnosis of dementia during the
measurement period.
Rationale: Drug therapies can reduce hospitalizations, but non-adherence
is high, ranging from 30% to
80%. There is an urgent need to identify cost-effective ways to improve
adherence and reduce
hospitalizations. Measure #1880 assesses chronic adherence using the
Proportion of Days Covered
(PDC) method for assessing medication adherence with a threshold of an
80 percent rate. This measure
describes the degree to which providers utilize mood stabilizer
medications in treating this disorder and
subsequent patient adherence.
Randomized, placebo-controlled trials have demonstrated the
effectiveness of mood stabilizers in
reducing the symptoms and probability of relapse for patients diagnosed
with bipolar I disorder (Smith,
Cornelius, Warnock, Bell, & Young, 2007; Tohen et al., 2005; Bowden et
al., 2005). This body of evidence
has spawned numerous clinical guidelines. The American Psychiatric
Association recommends with
“substantial clinical confidence” that the first-line of pharmacological
treatment for bipolar episodes, both
manic and depressive, includes the use of mood stabilizers (Hirshfeld,
2006). The Expert Consensus
Guideline Series states that “mood stabilizing medications are the
cornerstone of preventive maintenance
treatment” for patients with bipolar disorder (Keck et al., 2004). By
describing the degree of compliance
with these recommendations, this measure has the potential to reduce the
symptoms and probability of
relapse for patients diagnosed with bipolar I disorder.
Measure Type (Process/Outcome): Process
NQS Domain: Patient Safety
ID:
CUHSM8
NQF# 1927
eCQM# NA
Measure Title: Cardiovascular Health Screening for People With
Schizophrenia or Bipolar Disorder Who
Are Prescribed Antipsychotic Medications
Measure Description: The percentage of individuals 25 to 75 years
of age with schizophrenia or bipolar
disorder who were prescribed any antipsychotic medication and who
received a cardiovascular health
screening during the measurement year.
Numerator: Individuals who had one or more LDL-C screenings
performed during the measurement
year.
Denominator: Individuals ages 25 to 75 years of age by the end of
the measurement year with a
diagnosis of schizophrenia or bipolar disorder who were prescribed any
antipsychotic medication during
the measurement year.
Exclusions: Individuals are excluded from the denominator if they
were discharged alive for a coronary
artery bypass graft (CABG) or percutaneous coronary intervention (PCI)
(these events may occur in the
measurement year or year prior to the measurement year), or diagnosed
with ischemic vascular disease
(IVD) (this diagnosis must appear in both the measurement year and the
year prior to the measurement
year), chronic heart failure, or had a prior myocardial infarction
(identified in the measurement year or as
far back as possible).
Rationale:
Measure #1927 addresses a high impact area, as individuals with
schizophrenia or bipolar disorder are at
a greater risk for cardiovascular disease due to lifestyle risk factors,
and high non-treatment rates for
hyperlipidemia among people with schizophrenia.
- Research submitted shows that patients in this population receive
cholesterol screening 25 percent less
often than the general population, which demonstrates a significant
performance gap.
- Screening is a necessary step along the way to improving the health of
this population.
Measure Type (Process/Outcome): Process
NQS Domain: Patient Safety |
