NQF

Adult Workgroup Agenda Synopsis

Full Agenda

Measure Index

• NQF #1517 Prenatal and Postpartum Care: Postpartum Care

• NQF #0105: Antidepressant Medication Management (AMM-AD)
• NQF #0139: Pediatric Central Line-Associated Bloodstream Infections (CLABSI-CH)
• Use of Multiple Concurrent Antipsychotics: Ages 1-17

• Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA-AD)
• Adolescent Well-Care Visits: Ages 12-21
• NQF #0018 Controlling High Blood Pressure: Ages 18-85
• NQF #0038: Childhood Immunization Status (CIS-CH)
• NQF #1392 Well-Child Visits: First 15 Months
• NQF #1448: Developmental Screening in the First Three Years of Life (DEV-CH)
• NQF #1768: Plan All-Cause Readmissions (PCR-AD)
• NQF #2940 Use of Opioids at High Dosage in Persons Without Cancer

Full Measure Information

Measure Specifications

• NQF Number (if applicable): 1517
  
  
• Description: The percentage of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care:Rate 1: Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester or within 42 days of enrollment in the organization. Rate 2: Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.
  
  
• Numerator: This measure assesses whether pregnant women had timely prenatal and postpartum care visits. It has two rates, one assessing the timeliness of prenatal visits, and one assessing the timeliness of postpartum visits.
  
  
• Denominator: The percentage of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year.
  
  
• Exclusions: Non-live births
  
  
• Endorsement Status: Not Endorsed
  
  
• Endorsement Status Notes: Endorsement Removed
  
  
• Measure Type: Process
  
  
• Data Source: Claims; Electronic Health Records; Paper Medical Records
  
  
• Level of analysis: Health Plan; Integrated Delivery System
  
  
• Care Setting: Outpatient Services
  
  
• Use in Federal Programs: Qualified Health Plan (QHP) Quality Rating System (QRS)
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: Lead Discussant: Julia Logan
  
  

Measure Specifications

• NQF Number (if applicable): 0105
  
  
• Description: The percentage of members 18 years of age and older who were treated antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.a) Effective Acute Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b) Effective Continuation Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).a) Effective Acute Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). b) Effective Continuation Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).
  
  
• Numerator: Adults 18 years of age and older who were newly treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment.
  
  
• Denominator: Patients 18 years of age and older with a diagnosis of major depression and were newly treated with antidepressant medication.
  
  
• Exclusions: Exclude patients who use hospice services or elect to use a hospice benefit any time during the measurement year, regardless of when the services began.Exclude patients who did not have a diagnosis of major depression in an inpatient, outpatient, ED, telehealth, intensive outpatient or partial hospitalization setting during the 121-day period from 60 days prior to the IPSD, through the IPSD and the 60 days after the IPSD.Exclude patients who filled a prescription for an antidepressant 105 days prior to the IPSD.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type: Process
  
  
• Data Source: Claims
  
  
• Level of analysis: Health Plan
  
  
• Care Setting: Outpatient Services
  
  
• Use in Federal Programs: Qualified Health Plan (QHP) Quality Rating System (QRS) and Merit-Based Incentive Payment System (MIPS) (Finalized)
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: n/a
  
  

Summary of NQF Staff Preliminary Analysis

• QPS Link: http://www.qualityforum.org/QPS/0105
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; Behavioral health-depression
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; Process measure. Qualified Health Plan (QHP) Quality Rating System (QRS) and Merit-Based Incentive Payment System (MIPS) (Finalized)
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; Supports alignment
  
  
• Can the measure can be feasibly reported? : Yes; Reported in quality programs and payment programs
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Both Medicaid Adult and Child sensitive?: No; Adult only
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Addresses behavioral health-depression which is a prevalent co-morbidity for chronically ill individuals as well as costly as a condition that can lead to and/or exacerbate SUDs
  
  
• Lead Discussant: Sarah Brooks
  
  

Measure Specifications

• NQF Number (if applicable): 0139
  
  
• Description: Standardized Infection Ratio (SIR) and Adjusted Ranking Metric (ARM) of healthcare-associated, central line-associated bloodstream infections (CLABSI) will be calculated among patients in bedded inpatient care locations. This includes acute care general hospitals, long-term acute care hospitals, rehabilitation hospitals, oncology hospitals, and behavioral health hospitals.
  
  
• Numerator: Total number of observed healthcare-associated CLABSI among patients in bedded inpatient care locations.
  
  
• Denominator: Total number of predicted healthcare-associated CLABSI among patients in bedded inpatient care locations, calculated using the facility’s number of central line days and the following significant risk factors: • Acute Care Hospitals: CDC location, facility bedsize, medical school affiliation, facility type, birthweight category (NICU locations only)• Critical Access Hospitals: no significant risk factors, calculation based on pooled mean rate• Inpatient Rehabilitation Facilities: no significant risk factors, calculation based on pooled mean rate• Long Term Acute Care Hospitals: CDC location, facility bedsize, average length of stay
  
  
• Exclusions: The following devices are excluded as central lines: o Pacemaker wires and other non-lumened devices inserted into central blood vessels or the heart o Arterial catheterso Arteriovenous fistulao Arteriovenous grafto Extracorporeal membrane oxygenation (ECMO)o Hemodialysis reliable outflow (HERO) dialysis catheterso Intra-aortic balloon pump (IABP) deviceso Non-accessed central line (not accessed nor inserted during the hospitalization)o Peripheral IV or Midlineso Ventricular Assist Device (VAD)
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type: Outcome
  
  
• Data Source: Electronic health data; electronic health records; paper medical records; other
  
  
• Level of analysis: Facility; Population: Regional and State; Other
  
  
• Care Setting: Inpatient/Hospital; Post-Acute Care; Home Care; Other
  
  
• Use in Federal Programs: Hospital Compare and In-Patient Quality Reporting
  
  
• Steward: Centers for Disease Control and Prevention
  
  
• NQF Staff Notes: n/a
  
  

Summary of NQF Staff Preliminary Analysis

• QPS Link: http://www.qualityforum.org/QPS/0139
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; Patient safety-hospital based infections
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; Outcome measure. Hospital Compare and In-Patient Quality Reporting
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; Current use in Hospital Compare and In-Patient Quality Reporting
  
  
• Can the measure can be feasibly reported? : Yes; Current use in Hospital Compare and In-Patient Quality Reporting
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes
  
  
• Both Medicaid Adult and Child sensitive?: No; Child only but CLABSI is an important issue for both populations
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Improves patient safety
  
  
• Lead Discussant: Stephen Lawless
  
  

Measure Specifications

• NQF Number (if applicable): n/a
  
  
• Description: Percentage of children and adolescents ages 1 to 17 who were treated with antipsychotic medications and who were on two or more concurrent antipsychotic medications for at least 90 consecutive days during the measurement year.Note: A lower rate indicates better performance.
  
  
• Numerator: Beneficiaries on two or more concurrent antipsychotic medications for at least 90 consecutive days during the measurement year. Do not include denied claims. Use the steps below to determine the numerator.Step 1For each beneficiary, identify Drug ID, identify all drug events identified in step 4 of the event/diagnosis criteria (used to identify the eligible population [denominator]). Exclude denied claims and recalculate start dates and end dates (using steps 1-4 of the event/diagnosis criteria used to identify the eligible population [denominator]).Step 2Identify concurrent antipsychotic medication treatment events as follows:- For each beneficiary, identify the first day during the measurement year when the beneficiary was treated with two or more different antipsychotic medications (use the Drug ID field in the Medication List Directory (MLD) of NDC codes to identify different drugs available at http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2018/hedis-2018-ndc-license/hedis-2018-final-ndc-lists). This is the concurrent antipsychotic medication treatment event start date.- Beginning with (and including) the start date, identify the number of consecutive days the beneficiary remains on two or more different antipsychotic medications. If the number of days is =90 days, the beneficiary is numerator compliant.- If the number of consecutive days on multiple antipsychotic medications is <90 days, identify the end date and identify the next day during the measurement year when the beneficiary was treated with two or more different antipsychotic medications. If the number of days between the end date and the next start date is =15 days, include the days in the concurrent antipsychotic medication treatment event (concurrent antipsychotic medication treatment events allow a gap of up to 15 days).- If the number of days between the end date and the next start date exceeds 15 days, end the event; using the new start date, continue to assess for concurrent antipsychotic medication treatment events.- Continue this process until the number of concurrent antipsychotic medication treatment days is =90 consecutive days (i.e., the beneficiary is numerator compliant) or until the measurement year is exhausted (i.e., no concurrent antipsychotic medication treatment events were identified during the measurement year).Note:- Although denied claims are not included when assessing the numerator, all claims (paid, suspended, pending and denied) must be included when identifying the eligible population. Version
  
  
• Denominator: The eligible population.
  
  
• Exclusions: n/a
  
  
• Endorsement Status: Not Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type:
  
  
• Data Source: Administrative
  
  
• Level of analysis:
  
  
• Care Setting:
  
  
• Use in Federal Programs: n/a
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: Lead Discussants: Laura Jacobus-Kantor and David Einzig
  
  

Measure Specifications

• NQF Number (if applicable): n/a
  
  
• Description: Percentage of beneficiaries ages 19 to 64 with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80 percent of their treatment period during the measurement year.
  
  
• Numerator: The number of beneficiaries who achieved a PDC of at least 80 percent for their antipsychotic medications (Oral Antipsychotic Medications List; Long-Acting Injection 14 Days Supply Medications List; Long-Acting Injections 28 Days Supply Medications List)
  
  
• Denominator: The eligible population
  
  
• Exclusions: n/a
  
  
• Endorsement Status: Not Endorsed
  
  
• Endorsement Status Notes: The Adult Core Set includes the NCQA version of the measure, which is adapted from the CMS measure (NQF #1879).
  
  
• Measure Type:
  
  
• Data Source: Administrative
  
  
• Level of analysis:
  
  
• Care Setting:
  
  
• Use in Federal Programs:
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: n/a
  
  

Summary of NQF Staff Preliminary Analysis

• QPS Link: n/a
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; Behavioral health, SUD
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: No, Adherence to Antipsychotic Medications for Individuals with Schizophrenia is not in use in federal programs; Intermediate Outcome, registry based
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; The measure is currently included on the CMS Adult Core Set. Adherence to medication is key in in avoiding consequences of nonadherence including risk of relapse, hospitalization and suicide. Improving adherence will have a positive impact on population health outcomes.
  
  
• Can the measure can be feasibly reported? : Yes
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: No; measure is adapted from NQF 1879
  
  
• Both Medicaid Adult and Child sensitive?: No; Adult only
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Lower behavioral health/SUD costs and improve patient health
  
  
• Lead Discussant: Mary Applegate
  
  

Measure Specifications

• NQF Number (if applicable): n/a
  
  
• Description: Percentage of adolescents ages 12 to 21 who had at least one comprehensive well-care visit with a primary care practitioner (PCP) or an obstetric/gynecologic (OB/GYN) practitioner during the measurement year.
  
  
• Numerator: Administrative: At least one comprehensive well-care visit (Well-Care Value Set) with a PCP or an OB/GYN practitioner during the measurement year. The practitioner does not have to be the practitioner assigned to the adolescent.Hybrid: At least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year, as documented through either administrative data or medical record review. The PCP does not have to be assigned to the adolescent.
  
  
• Denominator: Administrative: The eligible population.Hybrid: A systematic sample drawn from the eligible population.Use a sample size of 411, unless special circumstances apply. States may reduce the sample size using information from the current year’s administrative rate or the prior year’s audited, hybrid rate. Regardless of the selected sample size, NCQA recommends an oversample to allow for substitution in the event that cases in the original sample turn out to be ineligible for the measure. For additional information on using a reduced sample size, refer to Appendix B, Guidance for Selecting Sample Sizes for Hybrid Measures.
  
  
• Exclusions: n/a
  
  
• Endorsement Status: Not Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type:
  
  
• Data Source: Administrative or Hybrid
  
  
• Level of analysis:
  
  
• Care Setting:
  
  
• Use in Federal Programs: Qualified Health Plan (QHP) Quality Rating System (QRS)
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: Lead Discussant: Julia Logan
  
  

Measure Specifications

• NQF Number (if applicable): 0018
  
  
• Description: The percentage of patients 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure was adequately controlled during the measurement year based on the following criteria:- Patients 18–59 years of age whose blood pressure was <140/90 mm Hg.- Patients 60–85 years of age with a diagnosis of diabetes whose blood pressure was <140/90 mm Hg.- Patients 60–85 years of age without a diagnosis of diabetes whose blood pressure was <150/90 mm Hg.
  
  
• Numerator: The number of patients in the denominator whose most recent blood pressure (both systolic and diastolic) is adequately controlled during the measurement year based on the following criteria:- Patients 18–59 years of age whose blood pressure was <140/90 mm Hg.- Patients 60–85 years of age with a diagnosis of diabetes whose blood pressure was <140/90 mm Hg.- Patients 60–85 years of age without a diagnosis of diabetes whose blood pressure was <150/90 mm Hg.To determine if the member’s BP is adequately controlled, the representative BP must be identified.
  
  
• Denominator: Patients 18 to 85 years of age by the end of the measurement year who had at least one outpatient encounter with a diagnosis of hypertension during the first six months of the measurement year.
  
  
• Exclusions: Exclude all patients with evidence of end-stage renal disease (ESRD) or kidney transplant on or prior to the end of the measurement year. Documentation in the medical record must include a dated note indicating evidence of ESRD, kidney transplant or dialysis. Exclude all patients with a diagnosis of pregnancy during the measurement year.Exclude all patients who had a nonacute inpatient admission during the measurement year.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type: Outcome
  
  
• Data Source: Claims; Electronic Health Records; Paper Medical Records; Other
  
  
• Level of analysis: Health Plan; Integrated Delivery System
  
  
• Care Setting: Outpatient Services
  
  
• Use in Federal Programs: Medicare Part C Star Rating
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: Lead Discussant: Judy Zerzen
  
  

Measure Specifications

• NQF Number (if applicable): 0038
  
  
• Description: Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DtaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (HepA); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine.
  
  
• Numerator: Children who received the recommended vaccines by their second birthday.
  
  
• Denominator: Children who turn 2 years of age during the measurement year.
  
  
• Exclusions: Exclude children who had a contraindication for a specific vaccine from the denominator for all antigen rates. The denominator for all rates must be the same.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type: Process
  
  
• Data Source: Claims; electronic health records; paper medical records; Registry data
  
  
• Level of analysis: Health Plan; Integrated Delivery System
  
  
• Care Setting: Outpatient Services
  
  
• Use in Federal Programs: Qualified Health Plan (QHP) Quality Rating System (QRS) and Merit-Based Incentive Payment System (MIPS) (Finalized)
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: n/a
  
  

Summary of NQF Staff Preliminary Analysis

• QPS Link: http://www.qualityforum.org/QPS/0038
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; Improvement is needed nationally. If this measure is added, would remove Well Child Visits up to age 15 months which is currently on the Scorecard, as NQF 0038 serves as a proxy for well child care visits in the first 15 months of life
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Yes; Process measure.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: Yes; Improvement is needed nationally. If this measure is added, would remove Well Child Visits up to age 15 months which is currently on the Scorecard, as NQF 0038 serves as a proxy for well child care visits in the first 15 months of life
  
  
• Can the measure can be feasibly reported? : Yes; Part of physician payment programs, child core set
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes; Up for maintenance review, no change in measure specs
  
  
• Both Medicaid Adult and Child sensitive?: No; Child only
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Improve pediatric health which affects school, development etc
  
  
• Lead Discussant: Sally Turbyville, Jill Morrow-Gorton, and Julia Logan
  
  

Measure Specifications

• NQF Number (if applicable): 1392
  
  
• Description: Percentage of children 15 months old who had well-child visits with a primary care physician during the measurement year.
  
  
• Numerator: Children who received six or more well-child visits with a PCP during their first 15 months of life.
  
  
• Denominator: Children who turn 15 months old during the measurement year.
  
  
• Exclusions: This measure excludes children in hospice.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type: Process
  
  
• Data Source: Claims; Electronic Health Data; Paper Medical Records
  
  
• Level of analysis: Health Plan
  
  
• Care Setting: Outpatient Services
  
  
• Use in Federal Programs: Qualified Health Plan (QHP) Quality Rating System (QRS)
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: Lead Discussant: Julia Logan
  
  

Measure Specifications

• NQF Number (if applicable): 1448
  
  
• Description: The percentage of children screened for risk of developmental, behavioral and social delays using a standardized screening tool in the first three years of life. This is a measure of screening in the first three years of life that includes three, age-specific indicators assessing whether children are screened by 12 months of age, by 24 months of age and by 36 months of age.
  
  
• Numerator: The numerator identifies children who were screened for risk of developmental, behavioral and social delays using a standardized tool. National recommendations call for children to be screened at the 9, 18, and 24- OR 30-month well visits to ensure periodic screening in the first, second, and third years of life. The measure is based on three, age-specific indicators. Numerator 1: Children in Denominator 1 who had screening for risk of developmental, behavioral and social delays using a standardized screening tool that was documented by their first birthdayNumerator 2: Children in Denominator 2 who had screening for risk of developmental, behavioral and social delays using a standardized screening tool that was documented by their second birthdayNumerator 3: Children in Denominator 3 who had screening for risk of developmental, behavioral and social delays using a standardized screening tool that was documented by their third birthdayNumerator 4: Children in Denominator 4 who had screening for risk of developmental, behavioral and social delays using a standardized screening tool that was documented by their first, second or third birthday.
  
  
• Denominator: Children who meet the following eligibility requirement: Age:Children who turn 1, 2 or 3 years of age between January 1 and December 31 of the measurement year. Continuous Enrollment: Children who are enrolled continuously for 12 months prior to child’s 1st, 2nd or 3rd birthday. Allowable Gap No more than one gap in enrollment of up to 45 days during the measurement year. To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the beneficiary may not have more than a 1-month gap in coverage (i.e., a beneficiary whose coverage lapses for 2 months (60 days) is not considered continuously enrolled.
  
  
• Exclusions: None
  
  
• Endorsement Status: Not Endorsed
  
  
• Endorsement Status Notes: Endorsement Removed
  
  
• Measure Type: Process
  
  
• Data Source: Claims; electronic health records; paper medical records
  
  
• Level of analysis: Population: Regional and State
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: No
  
  
• Steward: Oregon Health and Science University
  
  
• NQF Staff Notes: n/a
  
  

Summary of NQF Staff Preliminary Analysis

• QPS Link: http://www.qualityforum.org/QPS/1448
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; The measure identifies children who were screened for risk of developmental, behavioral, and social delays using a standardized tool. This addresses the Promote Effective Prevention & Treatment of Chronic Diseases Domain on the Scorecard Pillar 1.
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Process Measure. Child Core Set measure being reported by 27 states.
  
  
• Does the measure contribute to efficient use of resources and/or supports alignment of measurement across programs?: No; Not being used in any other federal programs except the CHIPRA Core Measures program.
  
  
• Can the measure can be feasibly reported? : Yes; Data sources: claims, electronic Health Records and paper medical records. A measure using claims data can be feasibly reported.
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: No; endorsement removed
  
  
• Both Medicaid Adult and Child sensitive?: No; Child only
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: Improves pediatric health and development
  
  
• Lead Discussant: Richard Antonelli and David Kelley
  
  

Measure Specifications

• NQF Number (if applicable): 1768
  
  
• Description: For patients 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Data are reported in the following categories:1. Count of Index Hospital Stays* (denominator)2. Count of 30-Day Readmissions (numerator)3. Average Adjusted Probability of Readmission *An acute inpatient stay with a discharge during the first 11 months of the measurement year (e.g., on or between January 1 and December 1).
  
  
• Numerator: At least one acute unplanned readmission for any diagnosis within 30 days of the date of discharge from the Index Hospital Stay, that is on or between the second day of the measurement year and the end of the measurement year.
  
  
• Denominator: Patients age 18 and older with a discharge from an acute inpatient stay (Index Hospital Stay) on or between January 1 and December 1 of the measurement year.
  
  
• Exclusions: Exclusions are included in the definition of the denominator (see S.9). Exclusions include discharges for death, pregnancy, prerinatal condition, or a discharge that is followed by a planned admission within 30 days.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type: Process
  
  
• Data Source: Instrument-based data
  
  
• Level of analysis: Health Plan; Integrated Delivery System
  
  
• Care Setting: Other
  
  
• Use in Federal Programs: Medicare Part C Star Rating and Qualified Health Plan (QHP) Quality Rating System (QRS)
  
  
• Steward: NCQA
  
  
• NQF Staff Notes: n/a
  
  

Summary of NQF Staff Preliminary Analysis

• QPS Link: http://www.qualityforum.org/QPS/1768
  
  
• Does the measure address a critical quality objective and or gap area for the Medicaid population?: Yes; Measure identifies the number of acute inpatient stays followed by an unplanned acute readmission for any diagnosis within 30 days
  
  
• What type of measure? Consider reporting burden for states. Is this measure already used in other federal reporting programs?: Process measure. Medicare Part C Star Rating and Qualified Health Plan (QHP) Quality Rating System (QRS)
  
  
• Can the measure can be feasibly reported? : No; Instrument-based measure
  
  
• Is the measure NQF-endorsed or has been submitted for NQF-endorsement?: Yes; Last endorsed 2014
  
  
• Both Medicaid Adult and Child sensitive?: No; Adult only
  
  
• Summary: What is the potential impact of this measure on quality of care for Medicaid patients?: This measure can potentially improve transitions of care, readmission rates and care coordination.
  
  
• Lead Discussant: Jill Morrow-Gorton and Kim Elliott
  
  

Measure Specifications

• NQF Number (if applicable): 2940
  
  
• Description: The proportion (XX out of 1,000) of individuals without cancer receiving prescriptions for opioids with a daily dosage greater than 120mg morphine equivalent dose (MED) for 90 consecutive days or longer.
  
  
• Numerator: Any member in the denominator with opioid prescription claims where the MED is greater than 120mg for 90 consecutive days or longer
  
  
• Denominator: Any member with two or more prescription claims for opioids filled on at least two separate days, for which the sum of the days supply is greater than or equal to 15.
  
  
• Exclusions: Any member with a diagnosis for Cancer or a Prescription Drug Hierarchical Condition Category (RxHCC) 8, 9, 10, or 11 for Payment Year 2015; or RxHCC 15, 16, 17, 18, or 19 for Payment Year 2016 (see list in S.11 and S.2b); or a hospice indicator (Medicare Part D) from the enrollment database.
  
  
• Endorsement Status: Endorsed
  
  
• Endorsement Status Notes: n/a
  
  
• Measure Type: Process
  
  
• Data Source: Claims
  
  
• Level of analysis: Health Plan; Population: Regional and State; Other
  
  
• Care Setting: Outpatient Services; Other
  
  
• Use in Federal Programs: n/a
  
  
• Steward: Pharmacy Quality Alliance
  
  
• NQF Staff Notes: Lead Discussants: Lindsay Cogan
  
  

Domain Index

• Promoting communication & care coordination 
  
  
• Reducing harm in care delivery 
  
  
• Promoting prevention & treatment of chronic diseases 
  
  
• Strengthening engagement in care 
  
  
• Making care affordable 
  
  
• Working with communities to promote healthy living* 
  
  

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  You can, but we don't recommend it. Besides using a lot of paper (probably a couple hundred pages at least), you'll lose all the links that allow you to move around the document. For instance, if you're scrolling through the agenda and want to see more information about a particular measure, the electronic format will allow you to click a link, read more, and then go back. If you're on paper, there will be a lot of flipping through paper.
  
  
• How do I know that I'm looking at the most recent version?
  At the top left corner of the discussion guide is a version number. At the beginning of the in person meeting, the NQF staff will ask everyone to load the most recent discussion guide version and will check that everyone has the same version loaded.
  
  
• What electronic devices can I use to view the discussion guide?
  We tried to make this as universal as possible, so it should work on your laptop (PC, Mac, Linux), your tablet (iPad, Android), or your phone (iPhone, Android). It should also work on many types of browsers (IE, Firefox, Chrome, Safari, Opera, Dolphin,....). Please let us know if you have any problems, and we'll troubleshoot with you (and improve the discussion guide for the next go around).
  
  
• Why do I see weird characters in some places?
  Because we're joining data from many different sources, we do find some technical challenges. This generally shows up as strange characters--extra question marks, accented characters, or otherwise unusual items. We've been able to fix many of these problems, but not all. We ask that you bear with us as we improve this over time!
  
  

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