NQF 0059 Diabetes HbA1c Poor Control

The quality measure is defined as the percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had HbA1c > 9.0%.

The measure is needed as diabetes of either type may cause life threatening, life ending or life altering complications, including poor blood sugar control.

To generate diabetes HbA1c poor control report:

1.      From the horizontal menu, click REPORTS.

Fig 1: Reports menu

2.      The REPORTS page is displayed. In the REPORTS page, from the sub-menu, click Generate Report.

The Generate Report page is displayed.

Fig 2: Generate Report window

3.      From the Select drop-down list, select Clinical Quality Measures (CQM).

4.      Click the Calendar controls to select a From and To dates. For example, let us select January 1, 2013 as the From date and December 31, 2013 as the To date.

5.      Select a Provider from the drop-down list.

6.      From the CQM drop-down list, select Diabetes HbA1c Poor Control.

7.      Click Generate Report.

The following report is generated.

Fig 3: Diabetes HbA1c Poor Control Report

Provider name, NPI (National Provider Identification) number, and Report duration are displayed as a header (in yellow color) of the report.

The report displays the following information in the respective columns:

• Clinical Quality Measures (CQM): Describes the CQM.

• Total Patient: Total Patient data includes patients who meet all of the following criteria:

• Were at least 17 years and one day old on the first day of the reporting period.

• Were no more than 74 years and 364 days old on the first day of the reporting period.

• Eligible Instance: Eligible Instance data includes patients who meet all of the following criteria:

• All the patients who met the Total Patient criteria.

• In addition, the patient must satisfy one of the following conditions:

• Are either taking a diabetic medication.

• Or have current problem of diabetes with:

• One or more encounter as inpatient or ED.

• Two or more encounters as non acute inpatient ,outpatient or opthamology occurring on two different dates.

Note:

• Medication is captured in the application under Clinical > Prescription > Add/Edit.

• Diagnosis is captured in the application under Clinical > Diagnosis > Add/Edit.

• Encounter outpatient is captured in the application under Clinical > Diagnosis> Add/Edit through the Diagnosis field.

The following medicines are indicative of diabetes:

The ICD-9 codes for diagnosis of diabetes are:

The CPT codes that determine qualifying encounters are:

The ICD-9 codes that determine qualifying encounters are:

• Meets Performance: Meets Performance data includes patients who satisfy the following criteria:

• Have an HbA1c test result saved during the reporting that is greater than 9.0%.

Note:

• Laboratory test result is captured in the application under Clinical > Labs, Procedures & Radiology > Add/Edit.

The codes for HbA1c tests are:

• Exclusion Instances:

• Has current problem of Polycystic Ovaries and does not have:

• Current problem of diabetes with:

• One or more encounter as inpatient or ED.

• Two or more encounters as non acute inpatient ,outpatient or opthamology occurring on two different dates.

• Has current problem of either gestational diabetes or steroid induced diabetes and are taking a diabetic medication and does not have:

• Current problem of diabetes with:

• One or more encounter as inpatient or ED.

• Two or more encounters as non acute inpatient ,outpatient or opthamology occurring on two different dates.

The ICD-9 Codes for diagnosis given in exclusion conditions are:

The following image depicts the workflow for achieving the performance rate of this measure for Criteria 2.

Fig 4: Diabetes HbA1c Poor Control Report Workflow

Note:

• The above image satisfies one of the condition(s) mentioned as a part of each parameter (Total Patient, Eligible Instance, and Meets Performance) for achieving the overall Performance rate. You may generate the details using other conditions mentioned as part of each parameter.

• Performance Rate: Percentage of patients 18 to 75 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%.

• For example, in the image you see:

• Total Patients: 183

• Eligible Instance: 57

• Meets Performance (Diabetes HbA1c Poor Control): 2

• Exclusion Instances: 5

• Performance Rate : (Meet Performance ÷ (Eligible Instance – Exclusion Instance) )*100 = (2÷(57-5)) *100 = 3.8%

Tip:

To see the variations in Performance rate, parameters to be affected are:

• Eligible Instance: For satisfying its conditions, see:

• Prescription as this is section where medication is recorded.

• Diagnosis as this is the section where diagnosis and patient encounter are recorded.

• Meets Performance: For satisfying its conditions, see Lab Procedures & Radiology as this is the section lab results are recorded.