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The Importance of EHR Quality Measures & Diabetes Care


Joan is a previously healthy 48 year old woman who works as a school custodian and has no significant medical history. Over the last 4 months she has experienced blurry vision, frequent urination, weakness, and constant thirst. She went to see her doctor who discovered her blood sugar was 455 and her hemoglobin A1C was 10.3. The diagnosis of new onset diabetes was made and she was started on metformin and insulin.

Which Diabetes Care Quality Measures Count for Stage 1 2013 Meaningful Use?

  • Diabetes: HbA1c Poor Control (>9%) (NQF# 0059)
  • Diabetes: HbA1c Control (<8%) (NQF# 0575)
  • Diabetes: LDL Management and Control (NQF# 0064)
  • Diabetes: Blood Pressure Management (NQF# 0061)

Which Diabetes Care Quality Measures Count for Stage 1 & 2 2014 Meaningful Use?

Measuring & Improving Diabetes Care: A Real Impact on Your Patients

  • A 10-year follow up of United Kingdom Prospective Diabetes Study participants showed sustained benefits of an intensive strategy (sulfonylurea, insulin, or metformin) to control blood glucose levels 10 years after cessation of the intervention.1 These benefits include reductions in:
    • Microvascular risk,
    • Myocardial infarction, and
    • Death from any cause.
  • A meta-analysis of 18,686 individuals with diabetes who were followed for an average of 4.3 years, showed that a 1.5 mmol/L reduction in LDL cholesterol would prevent approximately a third of patients from having a major cardiovascular event.2
  • Steno-2 Study participants who were followed for an average of 13.3 years showed sustained beneficial effects with intensive interventions that included targeting glycated hemoglobin, cholesterol, and blood pressure.3
    • 20% absolute risk reduction in death from any cause
      • One out every 5 patients had a death from any cause prevented
    • 13% absolute risk reduction in death from cardiovascular causes
      • One out of every 8 patients had a death from cardiovascular disease prevented

Conclusion

Close attention to these 4 measures in Joan's care can substantially reduce her risk of many diabetes complications, including death. These are lasting benefits that can allow Joan to look forward to more good years of life ahead.

Clinical Quality Measure Information

Hemoglobin A1c Management

NQF# Description Numerator Denominator Exclusions
0059 Percentage of adult patients with diabetes aged 18-75 years with most recent A1c level greater than 9.0% (poor control) Patients whose most recent HbA1c results are:
  • > 9%, or
  • Missing, or
  • Not performed
Patients with:
  • 18-75 years of age
  • Diagnosis of diabetes (Type I or II)
Patients with:
  • Polycystic ovaries
  • Gestational diabetes
  • Steroid induced diabetes

Comprehensive Diabetes Care: HbA1c Control (<8.0%)

NQF# Description Numerator Denominator Exclusions
0575 The percentage of members 18 - 75 years of age with diabetes (type 1 and type 2) who had HbA1c control (<8.0%). Patients with:
  • Their most recent automated HbA1c level <8.0%.
Patients with:
  • Diabetes
  • 18 - 75 years of age
Patients with:
  • Polycystic ovaries
  • Gestational diabetes
  • Steroid induced diabetes

Diabetes Measure Pair: A. Lipid Management: low density lipoprotein cholesterol (LDL-C) <130        B. Lipid Management: LDL-C <100

NQF# Description Numerator Denominator Exclusions
NQF# Not Applicable A: Percentage of adult patients with diabetes aged 18-75 years with most recent (LDL-C) <130 mg/dL

B: Percentage of patients 18-75 years of age with diabetes whose most recent LDL-C test result during the measurement year was <100 mg/dL
Patients with:
  • The most recent LDL-C level <130mg/dL.
Patients with:
  • 18-75 years of age
  • Diagnosis of diabetes (Type I or II)
Patients with:
  • Polycystic ovaries
  • Gestational diabetes
  • Steroid induced diabetes

Diabetes: Blood Pressure Management:

NQF# Description Numerator Denominator Exclusions
0061 Percentage of patient visits with blood pressure measurement recorded among all patient visits for patients aged > 18 years with diagnosed hypertension. Patients with
  • Systolic blood pressure measurement <140 mm Hg and
  • Diastolic blood pressure <80 mm Hg
Patients with:
  • 18-75 years of age
  • Diagnosis of diabetes (Type I or II)
Patients with:
  • Polycystic ovaries
  • Gestational diabetes
  • Steroid induced diabetes

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.4

  1. Holman, R., Paul, S., Bethel, M. A., Matthews, D., Neil, H. A. "10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes". New England Journal of Medicine 359 (2008): 1577-89.
  2. Cholesterol Treatment Trialists' Collaborators. "Efficacy of Cholesterol-Lowering Therapy in 18,686 People with Diabetes in 14 Randomised Trials of Statins: A Meta-Analysis". The Lancet 371 (2008): 117-25.
  3. Gaede, P., Lund Anderson, H., Parving, H., Pederson, O. "Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes". New England Journal of Medicine. 358 (2008): 580-91.
  4. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed December 6, 2011

Produced by Meaningful Use Quality Workgroup – February 14, 2013

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